A middle aged man presents with a history of foot pain on walking for a few weeks. The patient has a history of long standing diabetes mellitus for more than 15 years. He has been on Metformin and Glyburide combination. His HGBA1C that was obtained 3 months ago revealed inadequate control at 9%. He reports pain and swelling in his right foot for about one month. On examination the foot is swollen & tender to touch. Neurlogical examination reveals loss of vibratory sensation and position sensation in bilateral feet. There is also impaired light touch until the level of knees bilaterally. Joint motion at the level of ankle is within normal limits. Complete blood count , creatinine and ESR are with in normal limits. Most likely working diagnosis for his right foot pain is :
a) Chronic Gout
b) Septic arthritis
c) Peripheral Neuropathy
d) Charcot arthropathy
e) Reflex Sympathetic Dystrophy
C
answer is c
ddddddd?
D
d
D.Charcoat Arthropathy/Neuroapathic joint
Most common Cause -1.Diabetes(now)
2.Syphilis(Charcot)(Ref-eMedicine)
Rx:Acute Phase-1.Immobilization-By Casting
2.Reduction of Stress-Decreasing the amount of wt bearing
d
SAJU why not just straight peripheral neuropathy that then became complicated?
thanks
Nathaly
Cheers Saju
Why not just straight peripheral neuropathy that then became complicated?
thanks
Nathaly
Answer D
Charcot arthropathy occurs as a complication of diabetes, syphilis, chronic alcoholism, leprosy, meningomyelocele, spinal cord injury, syringomyelia, renal dialysis, and congenital insensitivity to pain. Diabetes is considered to be the most common cause of Charcot arthropathy.
The autonomic neuropathy leads to abnormal bone formation, and the sensory neuropathy leads to an insensate joint that is susceptible to trauma. The development of abnormal bone with no ability to protect the joint results in gradual bone fracture and in the subluxation of the joint.
Acute Charcot arthropathy almost always presents with signs of inflammation. Profound unilateral swelling, an increase in local skin temperature (generally, an increase of 3-7 º above the nonaffected foot’s skin temperature), erythema, joint effusion, and bone resorption in an insensate foot are present. These characteristics, in the presence of intact skin and a loss of protective sensation, are often pathognomonic of acute Charcot arthropathy
Pain can occur in more than 75% of patients; however, the pain’s severity is significantly less than would be expected based on the severity of the clinical and/or radiographic findings. Instability and loss of joint function also may be present. Passive movement of the joint may reveal a “loose bag of bones.” Approximately 40% of patients with acute Charcot arthropathy have concomitant ulceration, which complicates the diagnosis and raises concerns that osteomyelitis is present.
d
c
D
D
c
is it c or d then?????
Long standing Diabetes, Sensory deficits eventually, what will happen to the joints? Sensation or pain is an important protective mechanism. In patients with severe neuropathy and those who have lost pain sensation, this protective mechanism is lost causing them to leave the limb or the joint in a position that continues to damage it! So what’s the answer?
duh !!! answer man c or d !?!!
The patient has signs of Peripheral Neuropathy in BOTH feet (loss of vibratory sensation, position sensation & impaired light touch), but the question is about the RIGHT one, which has the early signs of Charcot arthropathy (pain and swelling).
CORRECT ANSWER: D
Not (A) because there’s no even a clue to choose this one
Not (B) because there’s no fever
Not (C) because the question is about the right foot, not both
Not (E) This one could be confusing because the symptoms are the same, but it lacks joint stiffness. You can discard this one because there’s normal joint motion at the ankle.
Charcot Arthropathy
Right foot = D, Charcot Arthropathy.
c) Peripheral Neuropathy
Loss of pain sensation leaving the joint in a position that will damage it?laughable!!!
Answer is Charcot arthropathy. Next question is to Professor Oladipo, why is the reason laughable?The pathogenesis of the charcot’s arthropathy remains uncertain but probable reason is lack of proprioception secondary to peripheral neuropathy that may result in ligamentous laxity, increased range of joint movement, instability, and damage by minor trauma, to which the relatively insensitive neuropathic foot is prone.