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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuropathic arthropathy (Charcot's joint) is a relatively painless, progressive and degenerative condition due to underlying neurologic deficits. Although a variety of neurologic disorders may produce this arthropathy, diabetes mellitus has become the most common cause. In diabetes, the foot and ankle are the sites most often involved, particularly the tarsometatarsal and tarsal joints. In addition to neuropathy, trauma is an essential factor in producing the arthropathy.
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PMID:Neuropathic arthropathy in the diabetic foot. 65 62

Three phase radionuclide bone imaging procedures are used to differentiate cellulitis and osteomyelitis. Acute cellulitis is shown only as increased radioactivity in the blood flow and blood pool images; a persistent area of high activity in a delayed image is usually diagnosed as acute osteomyelitis. We present a patient with Charcot's joint secondary to diabetes mellitus whose three-phase bone imaging as well as radiographic studies revealed a consistent picture of acute osteomyelitis. In the appropriate clinical setting, Charcot's joint, along with several other etiologies (including bone tumors, leukemia, trauma, recent surgery, Paget's disease, and malunion of fracture), should be included in the differential diagnosis.
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PMID:Diabetic Charcot joint mimicking acute osteomyelitis in radiography and three-phase radionuclide bone imaging study. 185 3

At the authors' institution from 1964 to 1984, ankle arthrodesis was performed in 13 patients with insulin-dependent diabetes mellitus who had a history of ankle sprain or fracture. Nine patients were diagnosed by clinical exam as having a peripheral neuropathy; nine patients had roentgenographic evidence of neuropathic arthropathy prior to surgery. Follow-up study with examination and roentgenograms averaged 42 months. Clinical and roentgenographic union was achieved in seven ankles at an average of 16 weeks. Two patients developed a nonunion, three had an amputation, and one died at two months postoperatively. Thirteen complications occurred in eight of the 13 patients (62%). Twenty reoperations, excluding pin removal, were performed in eight patients (62%). A satisfactory result was achieved in only 50% overall and in only 38% of patients with roentgenographic changes of neuropathic arthropathy. Neuropathic arthropathy contributes to the inordinate complication and failure rates. Ankle arthrodesis should be considered with caution in the diabetic patient.
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PMID:Arthrodesis of the diabetic neuropathic ankle joint. 231 76

Diabetes mellitus is associated with several non articular rheumatic conditions and is a cause of Charcot's arthropathy. We report three cases of long-standing insulin-dependent diabetics who developed an inflammatory monoarthritis of the ankle. There was no evidence of a peripheral neuropathy or sepsis. They were all seronegative for rheumatoid factor. In two the synovitis persisted; in the third there was a gradual resolution. This type of inflammatory synovitis has not been previously described in diabetes. It developed after a mean duration of diabetes of 34.3 years (range 18-52 years). We suggest that it may be associated with microvascular changes in diabetes, possibly involving hypoxic reperfusion.
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PMID:Monoarthritis of the ankle in diabetes mellitus without neuropathy: a report of three cases. 239 Aug 52

The pathologic aspects of an uncommon complication of diabetes mellitus, destructive arthropathy (Charcot's joint), were studied. The peripheral nerve demyelination resulting in clinically demonstrable deficits in perception of pain and vibration and in reflexes in the lower extremities reinforces the neurogenic role in this complication.
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PMID:Diabetic neuroarthropathy (Charcot's joint). 689 50

This 4-year prospective study investigated the reasons for high levels of gangrene and major amputation in diabetic renal transplant patients and whether regular multidisciplinary foot care could reduce morbidity. All foot lesions were documented and investigated in 50 diabetic patients, mean age 49.2 +/- 11.0 (SD) years, duration of diabetes 25.3 +/- 9.0 years, time since renal transplantation 60.2 +/- 35.1 months, who attended a special foot clinic monthly for education, vascular and neurological assessment, podiatry and footwear. Foot lesions included: neuropathic ulcers, ischaemic ulcers, traumatic lesions, Charcot's arthropathy, pathological fracture. Treatment included antibiotics, podiatry, footwear, and angioplasty or distal bypass where appropriate. Only 13 patients were deemed ischaemic but peripheral neuropathy was a very common finding (mean VPT 24.8 +/- 12.9 V). Gangrene and major amputations showed a decrease on previous years and healing times for lesions were similar to those previously reported in diabetic patients without renal transplants. The majority of foot lesions, both in soft tissue and bone, were related to neuropathy and trauma and responded well to optimal foot care within the renal unit. Gangrene and major amputations were usually preventable.
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PMID:Reduction of gangrene and amputations in diabetic renal transplant patients: the role of a special foot clinic. 755 88

The aim of this study is to compare the effectiveness of total contact casts based on wound location in groups of patients with diabetes mellitus with neuropathic ulcerations under the forefoot and patients with midfoot ulcerations associated with acute Charcot's arthropathy. Twenty-five consecutive diabetic patients with Meggitt-Wagner grade I neuropathic foot ulceration (NU) and 22 consecutive diabetic patients with neuropathic ulceration and acute Charcot's arthropathy (CU) were selected for study. Larger wounds took longer to heal in both the CU (p < 0.0001) and NU groups (p < 0.0001). Duration of ulcer prior to treatment also was significantly associated with increased healing time in both groups (p = 0.008 NU, p = 0.03 CU). The CU group had larger wounds (10.3 +/- 4.6 vs 7.7 +/- 4.0 cm2, p = 0.04) but took significantly less time to heal (28.4 +/- 13.0 vs 38.8 +/- 21.3 days, p = 0.04) than did subjects with neuropathic ulcerations only. The NU group had their ulcers present for a significantly longer period of time prior to contact casting (88.5 +/- 98.3 vs 17.7 +/- 12.9 days, p = 0.001). In this study, subjects with ulcerations secondary to acute Charcot fractures healed more rapidly than in previous reports with healing times of forefoot neuropathic ulcers similar to previous studies. Every patient's ulcer healed. There were no cast-related ulcerations, infections, or hospitalizations. Concerns regarding the safety of total contact casts to treat well-vascularized superficial forefoot and midfoot plantar wounds appear to be unfounded.
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PMID:Healing rates of diabetic foot ulcers associated with midfoot fracture due to Charcot's arthropathy. 901 53

Neuropathic arthropathy (Charcot joint) is a progressive and degenerative process resulting from underlying neurovascular and neurotraumatic deficits. Diabetes mellitus is now the most common cause of Charcot joint. A marked predilection for the tarsometatarsal, tarsal, and ankle joints occurs. Involvement of large weight-bearing joints such as the knee is rare. When the knee is involved, and conservative treatment fails, standard surgical intervention often involves arthrodesis. Arthroplasty is relatively contraindicated. The authors report a case of a 61-year-old, diabetic-woman with bilateral Charcot knees who successfully completed a rehabilitation program and achieved independence after left knee arthrodesis and right total knee arthroplasty.
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PMID:Total knee arthroplasty in a patient with bilateral Charcot knees. 922 85

Three middle-aged patients with diabetes sustained fractures of the acetabulum which were treated by open reduction and internal fixation. In each, rapid dissolution of the femoral head occurred with minimal discomfort, typical of a Charcot arthropathy. The patients had no other evidence of neuropathic arthropathy. Charcot changes may occur after high-energy trauma in patients with diabetes.
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PMID:Charcot arthropathy after acetabular fracture. 933 Oct 27

With the possible exception of osteomyelitis, Charcot's arthropathy is perhaps the most debilitating orthopedic sequela of diabetes mellitus. For this reason, early diagnosis and aggressive, noncompromising immobilization, pressure reduction, and consistent follow-through are paramount to effecting an acceptable result.
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PMID:Acute Charcot's arthropathy of the foot and ankle. 944 98


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