Charcot neuroarthropathy: Surgical and conservative treatment approaches

• 成果类型: Review
• 署名作者: Hurst, Michael; Shin, Laura
• 署名单位: University of Southern California
• 刊物名称: SEMINARS IN VASCULAR SURGERY
• ISSN/ISSBN: 0895-7967; 1558-4518
• DOI: 10.1053/j.semvascsurg.2025.01.004
• 发表日期: 2025-03
• 页码: 74-84
• 关键词: Charcot; Limb salvage; amputation; Vascular; Foot infection; DIABETIC FOOT ULCERS; management; ARTHROPATHY; RISK

摘要

Charcot neuroarthropathy (CN) is an inflammatory condition affecting the joints of patients with peripheral neuropathy; its prevalence is as high as 7.5%. It is commonly seen in patients with diabetes and poses a significant public health burden. CN often leads to severe morbidity, with complications including ulcerations, infections, and lower extremity amputations, and a 5-year mortality rate of 29.0%. The etiology of this condition is a combination of inflammation, neurotrauma, and altered bone metabolism, necessitating early identification and accurate diagnosis through clinical evaluation and imaging studies. Conservative management, particularly total contact casting, plays a pivotal role in managing midfoot ulcers, demonstrating success in reducing plantar pressure and promoting ulcer healing. Surgical interventions are aimed to stabilize affected joints through techniques like arthrodesis and osteotomy and creating a plantigrade foot. Reconstructive options, including external and internal fixation, play a crucial role in the healing process. Postoperative management, including rehabilitation, is vital for successful outcomes, with surgical success rates varying based on procedures. CN is often misdiagnosed as gout, deep vein thrombosis, cellulitis, or infection, and diagnosis is often delayed in the acute care setting. Early diagnosis and intervention can significantly improve outcomes for these patients. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.