Search

Background: In the pathogenesis of diabetic neuropathic osteoarthropathy (Charcot's foot) fractures cause chronic destruction of soft tissue and bone structure. To improve an early diagnosis of Charcot foot, modern diagnostic imaging is mainly based on magnetic resonance imaging (MRI), for example in relation to the detection of cortical bone fractures., Objectives: In this study we investigated the cortical microstructure in cases of Charcot foot with respect to fractures and porosity in order to visualize local cortical defects. This may substantiate recent efforts in a reclassification based on MRI., Material and Methods: Using microcomputed tomography (microCT) we investigated bone parameters, such as cortical thickness and porosity in order to quantify the local metatarsal microstructure in cases of Charcot foot., Results: All bone samples showed a high degree of cortical porosity including pores that perforated the cortical bone. The data suggest that areas with reduced cortical thickness coincide with large cortical pores that may serve as initial points for fractures. Whether the detected microfractures are physiological or artefacts of preparation could not be determined., Conclusion: By means of microCT we were able to visualize and quantify the extent of cortical porosity for the first time in high resolution. The data suggest that both cortical fractures and cortical porosity play an important role in the pathogenesis in cases of Charcot foot.

Background: Early recognition of Charcot foot can save a long period of suffering for the patient, high doctor and hospital costs and ultimately amputation., Objectives: This article aims to raise awareness of the diagnostics of Charcot foot also known as diabetic neuropathic osteoarthropathy (DNOAP) and the possible differential diagnostic options (e.g. diabetic foot, erysipelas and peripheral arterial occlusive disease)., Material and Methods: Clinical diagnostic pathways and classifications are presented and the resulting treatment options are discussed., Results: In recent years new technologies for wound treatment and interventional radiological optimization of vessels have been developed. Many promising surgical options are available for stabilizing and reconstructimg a plantigrade foot., Conclusion: Treatment of Charcot foot should be based on a structured diagnosis and classification. In addition to conservative treatment new surgical options are also available.

Background: The gold standard for treatment of early stages of Charcot foot are immobilization with a full contact plaster cast, whereby different periods and loading concepts are described in the literature., Objectives: The etiology, disease course and preparation for an early conservative therapy are described and a key point is a full contact plaster cast., Methods: An overview of the etiology, pathogenesis and indications for correct evaluation of the wound situation is given. The correct technique for the total cast is described and illustrated step by step with pictures., Results: If treatment of Charcot foot is initiated in the early stages prevention or healing of ulcers can be achieved; therefore, the correct indications and technique are necessary and the cast should be changed periodically which is a key point of the healing process. Healing results in a reduction of redness, temperature and swelling which should be measured and documented., Conclusions: Treatment of Charcot foot by full contact cast and immobilization should be initiated as soon as possible.