CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(04): 397-403
DOI: 10.1055/s-0039-3402460
Artigo de Atualização
Tornozelo e Pé

Pé diabético. Parte 2: Neuroartropatia de Charcot[*]

Article in several languages: português | English
1   Grupo de Cirurgia do Pé e Tornozelo, Departamento de Ortopedia e Traumatologia da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
› Author Affiliations

Resumo

A neuropatia de Charcot (NC) é uma complicação lamentável e comum de pacientes com diabetes, provavelmente resutlante de uma falta de entendimento adequado dessa condição, que leva ao diagnóstico tardio.A confusão diagnóstica com quadro infeccioso contribui para que o tratamento inicialmente indicado seja equivocado ao prescrever medicação antibiótica ou, eventualmente, drenagem cirúrgica. Não é infrequente que a drenagem inadvertida do suposto abcesso revele que na verdade seu conteúdo é formado apenas de partículas provenientes da destruição osteoarticular. A educação adequada, tanto dos pacientes diabéticos quanto dos médicos responsáveis por prestar atendimento primário a estes pacientes, é fundamental para a correta compreensão das principais características relacionadas ao desenvolvimento da NC. O ortopedista geral é quem, na maioria das vezes, recebe no pronto atendimento os pacientes que se encontram na fase aguda inicial da doença. Por esta razão, esses profissionais devem estar extremamente alertas e serem capazes de identificar os primeiros sinais que permitem diagnosticar precocemente a NC. Em tese, isto possibilitaria reduzir a morbidade desta afecção na medida em que o tratamento adequado venha a ser precocemente instituído.

* Trabalho desenvolvido no Grupo de Cirurgia do Pé e Tornozelo, Departamento de Ortopedia e Traumatologia da Santa Casa de Misericórdia de São Paulo, SP, Brasil.




Publication History

Received: 28 June 2019

Accepted: 13 September 2019

Article published online:
27 April 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 
  • Referências

  • 1 Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care 2011; 34 (06) 1249-1257
  • 2 Centers for Disease Control and Prevention. National Diabetics Statistics Report 2017. Department of Health and Human Services, Center for Disease Prevention and Control; 2017
  • 3 Del Core MA, Ahn J, Lewis 3rd RB. , et al. The evaluation and treatment of diabetic foot ulcers and diabetic foot infections. Foot Ankle Int 2018; 3 (1S): 13S-23S
  • 4 Brodsky JW. The diabetic foot. In: Mann RA, Coughlin MJ. , editors. Surgery of the Foot and Ankle. 6th ed. St Louis, MO: Mosby; 1993: 278-283
  • 5 Brodsky JW. Outpatient diagnosis and care of the diabetic foot. Instr Course Lect 1993; 42: 121-139
  • 6 Wukich DK, Raspovic KM, Suder NC. Patients with diabetic foot disease fear major lower-extremity amputation more than death. Foot Ankle Spec 2018; 11 (01) 17-21
  • 7 Peterson N, Widnall J, Evans P, Jackson G, Platt S. Diagnostic imaging of diabetic foot disorders. Foot Ankle Int 2017; 38 (01) 86-95
  • 8 Gibbons GW, Habershaw GM. Diabetic foot infections. Anatomy and surgery. Infect Dis Clin North Am 1995; 9 (01) 131-142
  • 9 Suder NC, Wukich DK. Prevalence of diabetic neuropathy in patients undergoing foot and ankle surgery. Foot Ankle Spec 2012; 5 (02) 97-101
  • 10 Game FL, Catlow R, Jones GR. , et al. Audit of acute Charcot's disease in the UK: the CDUK study. Diabetologia 2012; 55 (01) 32-35
  • 11 Gouveri E, Papanas N. Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice. World J Diabetes 2011; 2 (05) 59-65
  • 12 Rogers LC, Frykberg RG, Armstrong DG. , et al. The diabetic Charcot foot syndrome: a report of the joint task force on the Charcot foot by the American Diabetes Association and the American Podiatric Medical Association. Diabetes Care 2011; 34 (09) 2123-2129
  • 13 Fabrin J, Larsen K, Holstein PE. Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care 2000; 23 (06) 796-800
  • 14 Stuck RM, Sohn MW, Budiman-Mak E, Lee TA, Weiss KB. Charcot arthropathy risk elevation in the obese diabetic population. Am J Med 2008; 121 (11) 1008-1014
  • 15 Raspovic KM, Wukich DK. Self-reported quality of life and diabetic foot infections. J Foot Ankle Surg 2014; 53 (06) 716-719
  • 16 Dhawan V, Spratt KF, Pinzur MS, Baumhauer J, Rudicel S, Saltzman CL. Reliability of AOFAS diabetic foot questionnaire in Charcot arthropathy: stability, internal consistency, and measurable difference. Foot Ankle Int 2005; 26 (09) 717-731
  • 17 Raspovic KM, Hobizal KB, Rosario BL, Wukich DK. Midfoot Charcot neuroarthropathy in patients with diabetes: the impact f foot ulceration on self-reported quality of life. Foot Ankle Spec 2015; 8 (04) 255-259
  • 18 Pinzur MS, Evans A. Health-related quality of life in patients with Charcot foot. Am J Orthop 2003; 32 (10) 492-496
  • 19 van Baal J, Hubbard R, Game F, Jeffcoate W. Mortality associated with acute Charcot foot and neuropathic foot ulceration. Diabetes Care 2010; 33 (05) 1086-1089
  • 20 Ferreira RC, Gonçalez DH, Filho JM, Costa MT, Santin RAL. Midfoot Charcot arthropathy in diabetic patients: complication of an epidemic disease. Rev Bras Ortop 2015; 47 (05) 616-625
  • 21 Pinzur MS. An evidence-based introduction to Charcot foot artrhopathy. Foot Ankle Int. 2018; 3 (1S): 24S-31S
  • 22 Trepman E, Nihal A, Pinzur MS. Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int 2005; 26 (01) 46-63
  • 23 Pinzur MS, Kernan-Schroeder D, Emanuele NV, Emanuel M. Development of a nurse-provided health system strategy for diabetic foot care. Foot Ankle Int 2001; 22 (09) 744-746
  • 24 Myerson MS, Henderson MR, Saxby T, Short KW. Management of midfoot diabetic neuroarthropathy. Foot Ankle Int 1994; 15 (05) 233-241
  • 25 Wukich DK, Sadoskas D, Vaudreuil NJ, Fourman M. Comparision of diabetic Charcot patients with and without foot wounds. Foot Ankle Int 2017; 38 (02) 140-148
  • 26 Eichenholtz SN. Charcot Joints. Springfield, IL: C.C.Thomas; 1966
  • 27 Lepäntalo M, Apelqvist J, Setacci C. , et al. Chapter V: Diabetic foot. Eur J Vasc Endovasc Surg 2011; 42 (Suppl. 02) S60-S74
  • 28 Maloney N, Britt RC, Rushing GD. , et al. Insulin requirements in the intensive care unit in response to infection. Am Surg 2008; 74 (09) 845-848
  • 29 de Souza LJ. Charcot arthropathy and immobilization in a weight-bearing total contact cast. J Bone Joint Surg Am 2008; 90 (04) 754-759
  • 30 Pinzur MS. Current concepts review: Charcot arthropathy of the foot and ankle. Foot Ankle Int 2007; 28 (08) 952-959
  • 31 Johnson JE. Surgical treatment for neuropathic arthropathy of the foot and ankle. Instr Course Lect 1999; 48: 269-277
  • 32 Simon SR, Tejwani SG, Wilson DL, Santner TJ, Denniston NL. Arthrodesis as an early alternative to nonoperative management of charcot arthropathy of the diabetic foot. J Bone Joint Surg Am 2000; 82-A (07) 939-950
  • 33 Pinzur M. Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int 2004; 25 (08) 545-549
  • 34 Pinzur MS, Gil J, Belmares J. Treatment of osteomyelitis in charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation. Foot Ankle Int 2012; 33 (12) 1069-1074
  • 35 Strotman PK, Reif TJ, Pinzur MS. Current concepts: Charcot arthropathy of the foot and ankle. Foot Ankle Int 2016; 37 (11) 1255-1263
  • 36 Kroin E, Chaharbakhshi EO, Schiff A, Pinzur MS. Improvement in quality of life following operative correction of midtarsal Charcot foot deformity. Foot Ankle Int 2018; 39 (07) 808-811
  • 37 Sammarco VJ, Sammarco GJ, Walker Jr EW, Guiao RP. Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. J Bone Joint Surg Am 2009; 91 (01) 80-91
  • 38 Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res 1998; (349) 116-131
  • 39 Pinzur MS. Neutral ring fixation for high-risk nonplantigrade Charcot midfoot deformity. Foot Ankle Int 2007; 28 (09) 961-966
  • 40 Fonseca Filho FF, Ferreira RC, Stéfani KC, Costa MC. A haste intramedular bloqueada na fixação da artrodese tibiotalocalcânea. Rev Bras Ortop 2001; 36 (09) 352-355
  • 41 Ferreira RC, Silva AP, Costa MC. , et al. Aspectos epidemiológicos das lesões no pé e tornozelo do paciente diabético. Acta Ortop Bras 2010; 18 (03) 135-141
  • 42 Schneekloth BJ, Lowery NJ, Wukich DK. Charcot neuroarthropathy in patients with diabetes: an update systematic review of surgical management. J Foot Ankle Surg 2016; 55 (03) 586-590
  • 43 Ferreira RC, Mercadante MT. Artrodese do tornozelo com fixador externo de Ilizarov. Rev Bras Ortop 2004; 39 (03) 75-92
  • 44 Gershater MA, Löndahl M, Nyberg P. , et al. Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study. Diabetologia 2009; 52 (03) 398-407
  • 45 Gil J, Schiff AP, Pinzur MS. Cost comparison: limb salvage versus amputation in diabetic patients with charcot foot. Foot Ankle Int 2013; 34 (08) 1097-1099
  • 46 Robinson AH, Pasapula C, Brodsky JW. Surgical aspects of the diabetic foot. J Bone Joint Surg Br 2009; 91 (01) 1-7
  • 47 Wukich DK, Ahn J, Raspovic KM, La Fontaine J, Lavery LA. Improved quality of life after transtibial amputations in patients with diabetes-related foot complications. Int J Low Extrem Wounds 2017; 16 (02) 114-121
  • 48 Wukich DK, Pearson KT. Self-reported outcomes of trans-tibial amputations for non-reconstructable Charcot neuroarthropathy in patients with diabetes: a preliminary report. Diabet Med 2013; 30 (03) e87-e90