Triggering mechanisms of neuroarthropathy following conservative surgery for osteomyelitis

Diabet. Med. 27, 844–847 (2010) Background  The purpose of this study was to raise awareness and stimulate discussion of the possible triggering factors of Charcot neuroarthropathy by presenting the case of one patient who had both undergone surgery and was suffering from osteomyelitis. Case report ...

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Published in:Diabetic medicine 2010-07, Vol.27 (7), p.844-847
Main Authors: Aragón‐Sánchez, J., Lázaro‐Martínez, J. L., Hernández‐Herrero, M. J.
Format: Article
Language:English
Subjects:
Arthropathy, Neurogenic - etiology
Arthropathy, Neurogenic - physiopathology
Arthropathy, Neurogenic - surgery
Biological and medical sciences
charcot neuroarthropathy
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - physiopathology
Diabetes Mellitus, Type 2 - surgery
Diabetes. Impaired glucose tolerance
diabetic foot infections
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Feeding. Feeding behavior
foot ulcer
Fundamental and applied biological sciences. Psychology
Humans
Male
Medical sciences
Middle Aged
osteomyelitis
Osteomyelitis - complications
Osteomyelitis - physiopathology
Osteomyelitis - surgery
Postoperative Complications - etiology
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
Weight-Bearing - physiology
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Summary:Diabet. Med. 27, 844–847 (2010) Background  The purpose of this study was to raise awareness and stimulate discussion of the possible triggering factors of Charcot neuroarthropathy by presenting the case of one patient who had both undergone surgery and was suffering from osteomyelitis. Case report  We have extracted one case from our data set for a patient who underwent conservative surgery for osteomyelitis and subsequently developed acute Charcot in the midfoot. We present the clinical findings, photographs and X‐ray studies. Preoperative X‐ray showed irregular severe bone destruction in the fourth metatarsal head and a fracture of the fourth metatarsal bone. No signs of midfoot Charcot neuroarthropathy were found in this preoperative X‐ray. The third and fourth metatarsal bones were both removed and the surgical wound was left open to heal by second intention. Histopathological study confirmed osteomyelitis in the bone sample. Twenty‐five days after surgery, the surgical wound showed no signs of infection and healing progressed in a satisfactory way. However, the foot was swollen, erythematous and warm. Skin temperature was two degrees higher than the contralateral foot. X‐ray was taken and acute neuroarthropathy of the tarso‐metatarsal joints was diagnosed. Conclusions  Charcot neuroarthropathy appears to have been triggered by bone infection and/or surgery. We believe that the pivotal factor in the development of acute Charcot neuroarthropathy in this case was the weight bearing in the deformed foot so soon after the operation. Immobilization of the foot is critical as it serves to decrease the inflammation which has a key role in the development of Charcot neuroarthropathy.
ISSN:0742-3071
1464-5491
DOI:10.1111/j.1464-5491.2010.03019.x