Charcot-arthropathy in diabetes mellitus

Charcot's arthropathy is a relative uncommon complication of diabetic neuropathy. The aetiology remains poorly understood. According to the neurotraumatic theory, the foot, which has become insensitive through neuropathy, is subjected to extensive (micro)trauma through continuation of use. Ultimately this leads to destruction. According to the neurovascular theory, autonomic neuropathy results in an increased blood flow in the foot with osteopenia consequently resulting due to increased osteoclastic activity and decreased osteoblastic activity. Acute Charcot's arthropathy presents with a red, warm, swollen foot, which is usually not painful and which eventually becomes ulcerated. An insidious development of the condition is also possible. The X-ray of the foot often is normal at presentation, but will later show local osteoporosis, erosions, subluxations or fractures. Technetium scintigraphy will be abnormal from the beginning, while IgG scans are usually normal. The traditional treatment is cast immobilisation with careful introduction of protected weight-bearing. After stabilisation, orthopaedic footwear is necessary to improve foot function and to prevent ulceration. Regular checkups are important.