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Der Charcot-Fuß

  • Dirk Hochlenert
  • Gerald Engels
  • Stephan Morbach

Zusammenfassung

Teile der Pathogenese des Charcot-Fußes werden noch über 120 Jahre nach dem Tod von Jean-Martin Charcot kontrovers diskutiert und sind über das Stadium der Hypothese nicht hinausgekommen. Zusammenfassend basiert die Diagnostik insbesondere auf Klinik und MRT, die Therapie auf der Ruhigstellung. Chirurgische Verfahren können ergänzend eingesetzt werden. Der Stand der Diskussion über die Pathogenese sowie die aktuelle Entwicklung von Diagnostik und Therapie werden zusammenfassend dargestellt, eine neue Einteilung der natürlichen Geschichte wird eingeführt. Zusammenfassend ist von zentraler Bedeutung, den Verdacht auf einen Charcot-Fuß als Notfall einzustufen, da die frühzeitige Unterbrechung des Zerstörungsprozesses durch unverzügliche Einleitung einer angemessenen Therapie die Funktionsbeeinträchtigung bis hin zum Funktionsverlust des Beins zu verhindern vermag. Sollte die Diagnosesicherung nicht unverzüglich möglich sein, darf dies nicht zum Hinauszögern des Therapiebeginns führen.

Literatur

Literaturempfehlungen

  1. Frykberg RG (Hrsg) (2009) The Diabetic Charcot Foot: Principles and Management, 1. Aufl., 294 Seiten, ISBN-13: 978-1-57400-130-3. Kommentar: umfassender Text mit Einzelkapiteln zahlreicher amerikanischer und europäischer Autoren, der von der Pathogenese über den natürlichen Verlauf bis zum (konservativen und operativen) Management alle relevanten Aspekte des diabetischen Charcot- Fußes adressiert - erste internationale Buchpublikation, die sich exklusiv diesem Thema widmet.Google Scholar

Zitierte Literatur

  1. Aragon-Sanchez J, Lazaro-Martinez JL, Hernandez-Herrero MJ (2010) Triggering mechanisms of neuroarthropathy following conservative surgery for osteomyelitis. Diabet Med 27(7):844–847. doi:10.1111/j.1464-5491.2010.03019.xCrossRefPubMedGoogle Scholar
  2. Armstrong DG, Lavery LA (1997) Monitoring healing of acute Charcot's arthropathy with infrared dermal thermometry. JRehabil Res Dev 34(3):317–321Google Scholar
  3. Armstrong DG, Lavery LA, Liswood PJ, Todd WF, Tredwell JA (1997a) Infrared dermal thermometry for the high-risk diabetic foot. Physical Therapy 77(2):169–175; disc. 176–167Google Scholar
  4. Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR (1997b) The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic. Diabet Med 14(5):357–363. doi:10.1002/(SICI)1096-9136(199705)14:5<357::AID-DIA341>3.0.CO;2-8Google Scholar
  5. Baker N, Green A, Krishnan S, Rayman G (2007) Microvascular and C-fiber function in diabetic charcot neuroarthropathy and diabetic peripheral neuropathy. Diabetes Care 30(12):3077–3079. doi:10.2337/dc07-1163CrossRefPubMedGoogle Scholar
  6. Baumgartner R, Möller M, Stinus H (2013) Orthopädieschuhtechnik, 2. Aufl. C. Maurer Druck und Verlag GmbH & Co. KG, Geislingen/SteigeGoogle Scholar
  7. Berendt AR, Lipsky B (2004) Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot. Curr Diab Rep 4(6):424–429CrossRefPubMedGoogle Scholar
  8. Caputo GM, Ulbrecht J, Cavanagh PR, Juliano P (1998) The Charcot foot in diabetes: six key points. Am Fam Physician 57(11):2705–2710PubMedGoogle Scholar
  9. Chantelau E, Onvlee GJ (2006) Charcot foot in diabetes: farewell to the neurotrophic theory. Horm Metab Res 38(6):361–367. doi:10.1055/s-2006-944525CrossRefPubMedGoogle Scholar
  10. Chantelau EA, Grutzner G (2014) Is the Eichenholtz classification still valid for the diabetic Charcot foot? Swiss Med Wkly 144:w13948. doi:10.4414/smw.2014.13948PubMedGoogle Scholar
  11. Christensen TM, Simonsen L, Holstein PE, Svendsen OL, Bulow J (2011) Sympathetic neuropathy in diabetes mellitus patients does not elicit Charcot osteoarthropathy. J Diabetes Complications 25(5):320–324. doi:10.1016/j.jdiacomp.2011.06.006CrossRefPubMedGoogle Scholar
  12. Christensen TM, Gade-Rasmussen B, Pedersen LW, Hommel E, Holstein PE, Svendsen OL (2012) Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker. J Diabetes Complications 26(5):430–434. doi:10.1016/j. jdiacomp.2012.05.006CrossRefPubMedGoogle Scholar
  13. Colen LB, Kim CJ, Grant WP, Yeh JT, Hind B (2013) Achilles tendon lengthening: friend or foe in the diabetic foot? Plastic and reconstructive surgery 131(1):37e-43e. doi:10.1097/PRS.0b013e3182729e0bGoogle Scholar
  14. Duncan CP, Shim SS (1977) J. Edouard Samson Address: the autonomic nerve supply of bone. An experimental study of the intraosseous adrenergic nervi vasorum in the rabbit. J Bone Joint Surg Br 59(3):323–330PubMedGoogle Scholar
  15. Edelman SV, Kosofsky EM, Paul RA, Kozak GP (1987) Neuroosteoarthropathy (Charcot's joint) in diabetes mellitus following revascularization surgery. Three case reports and a review of the literature. Arch Intern Med 147(8):1504–1508CrossRefPubMedGoogle Scholar
  16. Edmonds ME, Roberts VC, Watkins PJ (1982) Blood flow in the diabetic neuropathic foot. Diabetologia 22(1):9–15CrossRefPubMedGoogle Scholar
  17. Eichenholtz SN (1966) Charcot joints. Charles C Thomas, Springfield, IL, S 3–8Google Scholar
  18. Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK, Andersen C, Vanore JV (2006) Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg 45(5 Suppl):S1–66. doi:10.1016/s1067- 2516(07)60001–5Google Scholar
  19. Game FL, Catlow R, Jones GR, Edmonds ME, Jude EB, Rayman G, Jeffcoate WJ (2012) Audit of acute Charcot's disease in the UK: the CDUK study. Diabetologia 55(1):32–35. doi:10.1007/s00125-011-2354-7CrossRefPubMedGoogle Scholar
  20. Herneth AM, Friedrich K, Weidekamm C, Schibany N, Krestan C, Czerny C, Kainberger F (2005) Diffusion weighted imaging of bone marrow pathologies. Eur J Radiol 55(1):74–83. doi:10.1016/j.ejrad.2005.03.031CrossRefPubMedGoogle Scholar
  21. Hoche G, Sanders LJ (1992) On some arthropathies apparently related to a lesion of the brain or spinal cord, by Dr J.-M. Charcot. January 1868. J Am Podiatr Med Assoc 82(8):403–411CrossRefPubMedGoogle Scholar
  22. Jeffcoate WJ, Game F, Cavanagh PR (2005) The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. The Lancet 366(9502):2058–2061. doi:10.1016/s0140-6736(05)67029-8CrossRefGoogle Scholar
  23. Kiuru MJ, Pihlajamaki HK, Ahovuo JA (2004) Bone stress injuries. Acta Radiol 45(3):317–326CrossRefPubMedGoogle Scholar
  24. Koller A, Springfeld R, Engels G, Fiedler R, Orthner E, Schrinner S, Sikorski A (2011) German-Austrian consensus on operative treatment of Charcot neuroarthropathy: a Perspective by the Charcot task force of the German Association for Foot Surgery. Diabet Foot Ankle 2. doi:10.3402/dfa. v2i0.10207Google Scholar
  25. Lowery NJ, Woods JB, Armstrong DG, Wukich DK (2012) Surgical management of Charcot neuroarthropathy of the foot and ankle: a systematic review. Foot Ankle Int 33(2):113–121. doi:10.3113/FAI.2012.0113CrossRefPubMedGoogle Scholar
  26. McGill M, Molyneaux L, Bolton T, Ioannou K, Uren R, Yue DK (2000) Response of Charcot's arthropathy to contact casting: assessment by quantitative techniques. Diabetologia 43(4):481–484. doi:10.1007/s001250051332CrossRefPubMedGoogle Scholar
  27. Morrison WB, Ledermann HP, Schweitzer ME (2001) MR imaging of the diabetic foot. Magn Reson Imaging Clin N Am 9(3):603–613, xiPubMedGoogle Scholar
  28. Mueller MJ, Sinacore DR, Hastings MK, Strube MJ, Johnson JE (2003) Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg Am 85-A(8):1436–1445PubMedGoogle Scholar
  29. Pakarinen TK, Laine HJ, Maenpaa H, Mattila P, Lahtela J (2009) Long-term outcome and quality of life in patients with Charcot foot. J Foot Ankle Surg 15(4):187–191. doi:10.1016/j.fas.2009.02.005CrossRefGoogle Scholar
  30. Palena LM, Brocco E, Ninkovic S, Volpe A, Manzi M (2013) Ischemic Charcot foot: different disease with different treatment? J Cardiovasc Surg 54(5):561–566Google Scholar
  31. Palestro CJ, Mehta HH, Patel M, Freeman SJ, Harrington WN, Tomas MB, Marwin SE (1998) Marrow versus infection in the Charcot joint: indium-111 leukocyte and technetium- 99m sulfur colloid scintigraphy. J Nucl Med 39(2):346–350PubMedGoogle Scholar
  32. Petrova NL, Edmonds ME (2008) Charcot neuro-osteoarthropathy- current standards. Diabet Metab Res Rev 24(Suppl 1):S58–S61. doi:10.1002/dmrr.846CrossRefGoogle Scholar
  33. Petrova NL, Foster AV, Edmonds ME (2004) Difference in presentation of charcot osteoarthropathy in type 1 compared with type 2 diabetes. Diabetes Care 27(5):1235–1236CrossRefPubMedGoogle Scholar
  34. Petrova NL, Moniz C, Elias DA, Buxton-Thomas M, Bates M, Edmonds ME (2007) Is there a systemic inflammatory response in the acute charcot foot? Diabetes Care 30(4):997–998. doi:10.2337/dc06-2168CrossRefPubMedGoogle Scholar
  35. Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, Hartemann A, Game F, Jeffcoate W, Jirkovska A, Jude E, Morbach S, Morrison WB, Pinzur M, Pitocco D, Sanders L, Wukich DK, Uccioli L (2011) The Charcot foot in diabetes. Diabetes Care 34(9):2123–2129. doi:10.2337/ dc11–0844Google Scholar
  36. Sanders LJ (2004) The Charcot foot: historical perspective 1827-2003. Diabet Metab Res Rev 20(Suppl 1):S4–S8. doi:10.1002/dmrr.451CrossRefGoogle Scholar
  37. Sinha S, Munichoodappa CS, Kozak GP (1972) Neuro-arthropathy (Charcot joints) in diabetes mellitus (clinical study of 101 cases). Medicine (Baltimore) 51(3):191–210CrossRefGoogle Scholar
  38. Sohn MW, Stuck RM, Pinzur M, Lee TA, Budiman-Mak E (2010) Lower-extremity amputation risk after charcot arthropathy and diabetic foot ulcer. Diabetes Care 33(1):98–100. doi:10.2337/dc09-1497CrossRefPubMedPubMedCentralGoogle Scholar
  39. Stuck RM, Sohn MW, Budiman-Mak E, Lee TA, Weiss KB (2008) Charcot arthropathy risk elevation in the obese diabetic population. Am J Med 121(11):1008–1114. doi:10.1016/ j.amjmed.2008.06.038CrossRefPubMedGoogle Scholar
  40. Tan AL, Greenstein A, Jarrett SJ, McGonagle D (2005) Acute neuropathic joint disease: a medical emergency? Diabetes Care 28(12):296 2–2964Google Scholar
  41. Wienemann T, Chantelau EA, Richter A (2012) Pressure pain perception at the injured foot: the impact of diabetic neuropathy. J Musculoskelet Neuronal Interact 12(4):254–261PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Dirk Hochlenert
    • 1
  • Gerald Engels
    • 2
  • Stephan Morbach
    • 3
  1. 1.Centrum für Diabetologie Endoskopie und WundheilungKölnGermany
  2. 2.Chirurgische Praxis am BayenthalgürtelKölnGermany
  3. 3.Marienkrankenhaus SoestSoestGermany

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