Charcot Neuroarthropathy: Current Concepts

Abstract

In orthopaedics, there are exceptionally few disease entities that are as poorly understood and devoid of evidence-based guidelines as there are with Charcot Neuroarthropathy (CN) of the lower extremity. CN is associated with high morbidity and mortality rates, with its financial impact on the healthcare system being substantial. The disease is likely due to the combination of the previously described neurovascular and neurotraumatic theories. Thus, physicians should highly suspect CN in any diabetic patient with ulcers or apparent deformities. The recognition and further classification of CN can then help guide further management, which includes both nonoperative and operative approaches. The optimal timing for surgical intervention remains unknown; however, some authors have successfully operated during the acute phase of the disease. Caring for the Charcot patient requires a multidisciplinary approach, including infectious disease specialists, endocrinologists, wound care teams, social workers, and surgeons. As there are no current widely accepted evidence-based guidelines or algorithms used to manage patients, our topical review provides a framework for understanding, diagnosing, staging, and managing a patient with CN in addition to the author’s preferred treatment method and our approach to a patient diagnosed with CN.