The Essentials of Charcot Neuroarthropathy

Biomechanics, Pathophysiology, and MRI Findings

1st Edition - May 11, 2022
Author: Claude Pierre-Jerome
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 9 3 5 2 - 4
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 9 5 7 8 - 8

The Essential Charcot Neuroarthropathy: Biomechanics, Pathophysiology, and MRI Findings provides a comprehensive analysis of Charcot neuroarthropathy (or Charcot Foot) in diabetic… Read more

The Essentials of Charcot Neuroarthropathy

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The Essential Charcot Neuroarthropathy: Biomechanics, Pathophysiology, and MRI Findings provides a comprehensive analysis of Charcot neuroarthropathy (or Charcot Foot) in diabetic patients. All aspects are covered, including epidemiology, biomechanics, pathophysiology, socioeconomic impacts, radiological findings, and differential diagnosis, with an emphasis on MRI. Chapters address the challenges of pre-and-post surgical management of Charcot neuroarthropathy and the role of unconventional imaging modalities in diagnosis. The book presents an analysis of the normal biomechanics of the ankle and foot, the biomechanical derangements of the ankle-foot unit (including abnormal gait) caused by diabetes Type II, and more.

Finally, there is also a reference of the pathophysiology of diabetes-induced peripheral neuropathy and its direct link with the development of Charcot neuroarthropathy foot. Diabetes-induced Charcot foot is frequently misunderstood, misinterpreted and misdiagnosed which can lead to confusion and detrimental management with reported high morbidity.

Cover image
Title page
Table of Contents
Copyright
List of contributors
Acknowledgments
Introduction
Chapter 1. Biomechanics of the ankle-foot unit: derangements and radiological signs
Abstract
1.1 Basic biomechanics of the normal ankle-foot unit
1.2 The ankle-foot unit: anatomy and structural organization
1.3 The plantar arches of the foot: biomechanical functions
1.4 The gait and gait cycle, normal biomechanics in the gait cycle
1.5 The swing phase
1.6 Muscle involvement in the gait phases, rocker action of the ankle-foot unit
1.7 Gait abnormalities in the diabetic foot
1.8 Biomechanical derangements of the diabetic foot: Charcot joint disease and limitation of joint motility
1.9 Plantar pressure abnormalities in diabetic peripheral neuropathy
1.10 Diabetic peripheral neuropathy and structural changes in bones, joints, and soft tissues
References
Chapter 2. Diabetes and Charcot neuroarthropathy: pathophysiology
Abstract
2.1 Diabetes: definition and general considerations
2.2 Pathophysiology of diabetes mellitus type 1 and type 2
2.3 Diabetes-induced Charcot neuroarthropathy
2.4 Charcot foot syndrome versus Charcot neuro-osteoarthropathy or Charcot neuropathic-sarco-osteoarthropathy
2.5 Theories of Charcot neuroarthropathy: the German theory and the French theory
2.6 Prevalence of Charcot neuroarthropathy
2.7 Conditions that influence the advent of Charcot neuroarthropathy
2.8 Symmetrical and asymmetrical neuropathy in relation to Charcot neuroarthropathy
2.9 Autonomic neuropathy and neuropathic edema
2.10 Nondiabetic conditions producing Charcot foot or Charcot neuroarthropathy
2.11 Complications of Charcot neuroarthropathy (bones and soft tissues)
2.12 Complications affecting soft tissues
2.13 Signs of remission and recurrence of Charcot neuroarthropathy
2.14 Role of imaging in Charcot neuroarthropathy
2.15 Differential diagnosis or common conditions that resemble Charcot neuroarthropathy
2.16 Prognosis of Charcot neuroarthropathy
2.17 Conclusion
References
Chapter 3. Epidemiology and socioeconomic impact of diabetes and Charcot neuroarthropathy
Abstract
3.1 Introduction
3.2 Diabetes mellitus type 2: epidemiology and prevalence worldwide
3.3 Diabetes mellitus type 2: effect of rapid economic development and modernization
3.4 Prevalence of diabetes mellitus type 2 in some countries
3.5 Common risk factors for diabetes mellitus type 2 complications
3.6 General costs of diabetes mellitus type 2 in the United States
3.7 Diabetes-induced Charcot neuroarthropathy
3.8 Risk factors for Charcot neuroarthropathy
3.9 Foot ulcerations in Charcot neuroarthropathy
3.10 Infection
3.11 Cost of foot ulceration
3.12 Foot amputation in Charcot neuroarthropathy
3.13 Depression, anxiety, dementia, and sexual dysfunction in Charcot neuroarthropathy
3.14 Life expectancy and mortality in Charcot neuroarthropathy
3.15 Conclusion
References
Chapter 4. Charcot neuroarthropathy: historical analysis and characteristics
Abstract
4.1 Charcot neuroarthropathy (the diabetic foot): definition and characteristics
4.2 Historical perspectives of Charcot neuroarthropathy
4.3 Epidemiology, incidence, prevalence, and ethnicity of diabetic foot disease
4.4 Risk factors and disorders producing the Charcot Foot
4.5 Development and presentation of Charcot neuroarthropathy: the theories (acute inflammation theory and neurotraumatic and neurovascular theory) and predisposing factors
4.6 Clinical presentation and distribution of Charcot involvement and the concept of “vicious cycle” and equinus deformity of the Charcot foot
4.7 Stages of Charcot neuroarthropathy
4.8 Classifications of Charcot neuroarthropathy based on anatomic locations: a meta-analysis
4.9 New classification: a proposed classification based on anatomy, biomechanics, and magnetic resonance imaging findings in bones and soft tissues
References
Chapter 5. Normal bone, bone deformity, and joint dislocation in Charcot neuroarthropathy
Abstract
5.1 Normal bone: infrastructure and biomechanical properties of bone
5.2 Biomechanical properties of bone
5.3 Loading and off-loading of the ankle-foot unit: generalities
5.4 Loading and off-loading of the foot in diabetes
5.5 Pathomechanics of the midfoot: mechanism of bone deformity
5.6 Joint dislocations in Charcot neuroarthropathy
5.7 Diagnostic imaging
5.8 Complications of Lisfranc dislocation
5.9 Toe deformities
5.10 Second ray syndrome
References
Chapter 6. Biomechanical behavior of bone. Fractures in Charcot neuroarthropathy
Abstract
6.1 The normal bone: biomechanical characteristics
6.2 Bone elasticity: cortical bone versus trabecular bone
6.3 Biomechanical behavior of bone: role of the bone matrix
6.4 Muscular activity and effects on bone
6.5 Bone geometry and effects on biomechanical behavior
6.6 Bone changes with aging: deterioration of intrinsic and extrinsic resistance
6.7 Changes in trabecular bone with aging
6.8 Bone remodeling: mechanism and characteristics
6.9 Diabetes type 2: effects on bone infrastructure
6.10 Fractures of the ankle–foot unit in diabetes mellitus
6.11 Stress fractures of the ankle–foot unit
6.12 DMT2 therapeutics and effects on bones
References
Further reading
Chapter 7. Osteomyelitis in Charcot neuroarthropathy
Abstract
7.1 Osteomyelitis: definition and history
7.2 Osteomyelitis: clinical characteristics and risk factors
7.3 Ulceration and osteomyelitis
7.4 Diagnosis of osteomyelitis in Charcot neuroarthropathy
7.5 Osteomyelitis versus Charcot neuroarthropathy
7.6 Osteomyelitis: generalities and pathogenesis in diabetes-related Charcot neuroarthropathy
7.7 Imaging of osteomyelitis in Charcot neuroarthropathy
References
Chapter 8. Differential diagnosis in Charcot neuroarthropathy
Abstract
8.1 Introduction
8.2 Common inflammatory conditions that resemble Charcot neuroarthropathy
8.3 Rheumatoid arthritis and Charcot neuroarthropathy
8.4 Osteoarthritis, diabetes, and Charcot neuroarthropathy
8.5 Gout and Charcot neuroarthropathy
8.6 Psoriasis arthritis and Charcot neuroarthropathy
8.7 Pseudogout and Charcot Neuroarthropathy
8.8 Infectious conditions that resemble diabetes-induced Charcot neuroarthropathy
8.9 Human immunodeficiency virus infection and Charcot neuroarthropathy
8.10 Nondiabetic conditions with underlying neurogenic arthropathy
8.11 Covid-19 infection and diabetes
References
Further reading
Chapter 9. The articular cartilage: biomechanics and damage in diabetes-induced Charcot neuroarthropathy
Abstract
9.1 Introduction
9.2 Articular cartilage: function, composition, and structure
9.3 Biomechanical behavior of articular cartilage
9.4 Biomechanics of cartilage degeneration
9.5 Metabolism of the cartilage: role of the chondrocytes
9.6 The link between diabetes and osteoarthritis
9.7 Risk factors for diabetes mellitus type 2 and osteoarthritis
9.8 Effects of diabetes mellitus type 2 and hyperglycemia on cartilage
9.9 Effects of diabetes mellitus type 2 and hyperglycemia on tendons and ligaments
9.10 Relevance of the triad: diabetes, arthritis, and obesity
9.11 Diabetes, osteoarthritis, and subchondral bone lesion
9.12 Diabetes and association with loss of cartilage and impairment of fracture repair
9.13 Magnetic resonance imaging of articular cartilage
References
Chapter 10. The skin: anatomy and pathologies in diabetes
Abstract
10.1 Introduction
10.2 Layers of the skin
10.3 Blood supply to the skin of ankle and foot
10.4 Innervation of the skin of the ankle-foot unit
10.5 Skin diseases in diabetes: prevalence and pathogenesis
10.6 Skin ulceration
10.7 Sinus tracts
10.8 Diabetic blisters (bullosis diabeticorum)
10.9 Callus and corns
10.10 Skin xerosis
10.11 Eruptive xanthomatosis
10.12 Madura foot (mycetoma)
References
Further reading
Chapter 11. Plantar subcutaneous fat pad and Kager fat pad and changes in Charcot neuroarthropathy
Abstract
11.1 The foot fat pads: generalities
11.2 The plantar fat pad: function, anatomy, and histology
11.3 Biomechanics of the plantar fat pad
11.4 Plantar fat pad and pressure distribution
11.5 Plantar fat pad atrophy: causes and pathophysiology
11.6 Effects of diabetes and hyperglycemia on the plantar fat tissue
11.7 The calcaneal fat pad
11.8 Diabetes mellitus type 2-related lesions in the plantar fat pad
11.9 The Kager fat pad
References
Chapter 12. The plantar aponeurosis: anatomy, pathomechanics, imaging, and pathologies related to Charcot neuroarthropathy
Abstract
12.1 The plantar aponeurosis: anatomy
12.2 MR anatomy of the plantar aponeurosis: relationship with adjacent structures
12.3 Pathomechanics of plantar aponeurosis
12.4 Pathologies of plantar aponeurosis in relation with diabetes and Charcot neuroarthropathy
12.5 Plantar fibromatosis
References
Chapter 13. The intrinsic and extrinsic muscles: anatomy and pathologies in diabetes-related Charcot neuroarthropathy
Abstract
13.1 The intrinsic plantar foot muscles
13.2 The extrinsic muscles
13.3 Pathomechanics of the foot muscles
13.4 Pathologies of the muscles in diabetes-related Charcot neuroarthropathy
13.5 Conclusion
References
Further reading
Chapter 14. The Achilles tendon: anatomy biomechanics and changes in Charcot neuroarthropathy
Abstract
14.1 Introduction
14.2 Achilles tendon anatomy
14.3 Biomechanics of the Achilles tendon
14.4 Pathologies of the Achilles tendon
References
Chapter 15. The tendons and ligaments of the ankle-foot unit, the tarsal tunnel, the sinus tarsi, fascial compartments of the ankle-foot unit, and changes seen in Charcot neuroarthropathy
Abstract
15.1 Introduction
15.2 The tendons of the ankle-foot unit
15.3 Imaging considerations
15.4 Tendon pathology (tendinosis, tear, and tenosynovitis)
15.5 Pathophysiology of tendon disease in diabetes and Charcot neuroarthropathy
15.6 Tendinosis
15.7 Tenosynovitis
15.8 Tendon rupture
15.9 The ligaments of the ankle-foot unit
15.10 The tarsal tunnel
15.11 The sinus tarsi
15.12 Fascial compartments of the ankle-foot unit
References
Further reading
Chapter 16. The synovium and bursae of the ankle-foot unit: anatomy and pathologies in Charcot neuroarthropathy
Abstract
16.1 The synovium
16.2 The synovial joints and the functions of the synovium
16.3 The synovium and the tendon: functions of the synovium
16.4 Pathologies of the synovium at the ankle-foot unit
16.5 The bursa
16.6 Pathology of the bursa: imaging
References
Further reading
Chapter 17. The vascular system of the ankle-foot unit: anatomy and pathologies in Charcot neuroarthropathy
Abstract
17.1 Anatomy of the vascular system of the ankle-foot unit
17.2 Pathologies of the vascular system
17.3 Role of imaging in peripheral arterial disease
17.4 Monckeberg’s arteriosclerosis
17.5 Muscle infarction in diabetic foot
17.6 Necrosis in Charcot neuroarthropathy
References
Chapter 18. The nervous system: innervations of the skeleton; bone homeostasis; and peripheral neuropathies (Baxter’s neuropathy, tarsal tunnel syndrome, and peroneal neuropathy)
Abstract
18.1 Introduction
18.2 The nervous system and innervations of the skeleton
18.3 The peripheral nervous system: somatic innervation of bones
18.4 Peripheral nervous system: autonomic (sympathetic and parasympathetic) innervation of bones
18.5 Characteristics of the skeleton and regulation of bone homeostasis
18.6 Autonomic innervation of the bone marrow
18.7 The bone marrow niche
18.8 Clinical relevance of diabetic autonomic neuropathy
18.9 Diabetic peripheral neuropathy and bone disease
18.10 Influence of the peripheral nervous system on bone growth, fracture healing, denervation, and heterotopic bone formation
18.11 Pathophysiology of bone pain
18.12 Peripheral neuropathies of ankle-foot unit: Baxter’s neuropathy, tarsal tunnel syndrome, and peroneal neuropathy
18.13 Peroneal neuropathies
18.14 Conclusion
References
Chapter 19. The surgical management of the Charcot foot: physical examination of the foot prior to surgery, indications and criteria for amputation, and surgical techniques
Abstract
19.1 Examination of the Charcot neuropathic foot
19.2 Current conservative management of Charcot neuropathic foot
19.3 Indications and criteria for surgery
19.4 Current surgical management of Charcot neuropathic foot
19.5 Amputation
19.6 Conclusion
References
Chapter 20. The operated Charcot foot: biomechanics of the operated foot and foot ulcerations and their management
Abstract
20.1 Biomechanics of the operated foot
20.2 Ulcerations: management and follow-up
20.3 Preventive measures for Charcot foot deformity: the role of footwear
20.4 Complications of the deformed Charcot foot
20.5 Surgical management of the deformed Charcot foot: rehabilitation
20.6 Psychosocial implications of the Charcot foot
References
Chapter 21. The surgical approach and follow-up of the complicated Charcot foot: general considerations
Abstract
21.1 Physical examination of the Charcot neuroarthropathic foot (diabetic foot)
21.2 Classifications
21.3 Current conservative management of Charcot neuropathic foot, diabetic foot infections, and preventative measures for skin ulcerations
21.4 Risk factors for diabetic foot ulcers
21.5 Indications and criteria for surgery and amputation
21.6 Surgical management of the infected diabetic foot and surgical techniques and prognosis
21.7 Surgical management of the deformed Charcot foot: postsurgical recovery and rehabilitation
21.8 Future nonoperative developments and surgical techniques
21.9 Imaging techniques
21.10 Diabetic foot ulcers: new debridement methods and wound healing strategies
References
Further reading
Chapter 22. Imaging modalities in Charcot neuroarthropathy: indications and usefulness
Abstract
22.1 Introduction
22.2 Radiography: indications
22.3 Ultrasonography: indications in Charcot neuroarthropathy
22.4 Computed tomography: indications in Charcot neuroarthropathy
22.5 Nuclear medicine: use in Charcot neuroarthropathy
22.6 Magnetic resonance imaging in Charcot neuroarthropathy
22.7 Magnetic resonance imaging: protocol and indications
References
Chapter 23. Considerations of different imaging techniques in the evaluation of Charcot neuroarthropathy (MR spectroscopy, MR diffusion tensor imaging-tractography, MR elastography, and positron emission tomography/magnetic resonance imaging)
Abstract
23.1 Introduction
23.2 Ultrasonography (Doppler, tractography) in Charcot neuroarthropathy
23.3 Dual-energy spectral computed tomography and positron emission tomography computed tomography in Charcot neuroarthropathy
23.4 Nuclear imaging in Charcot neuroarthropathy
23.5 Advanced MR techniques in Charcot neuroarthropathy
23.6 Magnetic resonance imaging of skeletal muscle: qualitative and quantitative techniques (MR spectroscopy, MR diffusion tensor imaging-tractography, MR elastography, and positron emission tomography/magnetic resonance imaging)
23.7 Areas of research needed in the future
References
Index

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Claude Pierre-Jerome