Charcot neuroarthropathy triggered and complicated by osteomyelitis. How limb salvage can be achieved

Background Charcot neuroarthropathy is a severe complication in the feet of patients with diabetes, which can lead to a major amputation. Osteomyelitis and surgery for osteomyelitis have been reported as trigger mechanisms of developing Charcot neuroarthropathy. However, the development of acute Cha...

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Bibliographic Details
Published in:Diabetic medicine 2013-06, Vol.30 (6), p.e229-e232
Main Authors: Aragón‐Sánchez, J., Lázaro‐Martínez, J. L., Quintana‐Marrero, Y., Álvaro‐Afonso, F. J., Hernández‐Herrero, M. J.
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Amputation
Antibiotics
Arthropathy, Neurogenic - complications
Arthropathy, Neurogenic - etiology
Arthropathy, Neurogenic - surgery
Arthropathy, Neurogenic - therapy
Combined Modality Therapy
Diabetes
Diabetic Foot - physiopathology
Foot Bones
Humans
Limb Salvage
Male
Middle Aged
Osteomyelitis - complications
Osteomyelitis - physiopathology
Osteomyelitis - surgery
Osteomyelitis - therapy
Salvage
Tarsal Joints
Treatment Outcome
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Summary:Background Charcot neuroarthropathy is a severe complication in the feet of patients with diabetes, which can lead to a major amputation. Osteomyelitis and surgery for osteomyelitis have been reported as trigger mechanisms of developing Charcot neuroarthropathy. However, the development of acute Charcot neuroarthropathy triggered by osteomyelitis during conservative antibiotic treatment is not well outlined in the medical literature. Case reports Two patients apparently developed mid and rear foot Charcot neuroarthropathy, which was clinically suspected while being treated with antibiotics for osteomyelitis. One of them presented osteomyelitis of the navicular bone and subsequently developed acute Charcot neuroarthropathy of the tarsometatarsal joints. The other presented calcaneal osteomyelitis with pathological fracture and developed Charcot neuroarthropathy of the transverse tarsal joint. No offloading had been implemented in either case. A major amputation had been indicated in both cases in their teaching hospitals. Limb salvage was achieved in both cases by means of surgery, culture‐guided post‐operative antibiotics, intraosseus instillation of super‐oxidized solution, bed rest before placing a total contact cast and stabilization of the unstable foot with a total contact cast with an opening for checking the healing course and to detect any complications. The mechanisms of the development of acute Charcot neuroarthropathy in a patient with osteomyelitis are discussed. Conclusions Osteomyelitis in the feet of patients with diabetes and neuropathy may trigger the development of acute Charcot neuroarthropathy. Fractures and dislocated joints may subsequently become infected from the index focus, producing a severe infected and unstable foot that may require a major amputation. Limb salvage can be achieved in specialized departments. What's new? The development of Charcot neuroarthropathy during conservative antibiotic treatment of osteomyelitis has not previously been addressed in the medical literature. The possibility that bone inflammation, together with the absence of offloading, may act as the trigger for onset of acute Charcot neuroarthropathy should not be underestimated. Interosseous oedema and bone debris attributable to Charcot neuroarthropathy become secondarily infected, causing a complex clinical picture that may lead to a major amputation. We describe the previous events, which led to this challenging complication and give the keys to ach
ISSN:0742-3071
1464-5491
DOI:10.1111/dme.12191