Diabetisch neuropathische Osteoarthropathie – Charcot-Fuß

Zusammenfassung

Die diabetisch neuropathische Osteoarthropathie (DNOAP, Charcot-Fuß) ist eine nichtinfektiöse Arthropathie, die sich in einem gut durchbluteten, insensitiven und biomechanisch alterierten Fuß entwickelt. Diabetes mellitus ist die häufigste Ursache der DNOAP, wobei die Veränderungen auch bei sensomotorischen Neuropathien anderer Genese auftreten. Die Pathogenese ist bisher nicht sicher aufgeklärt. Im Verlauf der Erkrankung tritt eine Knochen- und Gelenkdestruktion mit Fragmentation und anschließendem Remodelling der Gelenkstukturen auf. Charakteristischerweise präsentieren sich die Patienten mit einem warmen, geschwollenen und wenig schmerzhaften Fuß. Das Nativ-Röntgenbild ist diagnostisch wegweisend und wird in der differenzialdiagnostischen Abgrenzung gegenüber der Osteomyelitis durch die MR-Tomografie ergänzt. Die Therapie der DNOAP richtet sich nach dem Erkrankungsstadium. In der Frühphase der Erkrankung ist eine konsequente Druckentlastung von zentraler Bedeutung. Spätere Fußkomplikationen sind häufig, weshalb eine sorgfältige Verlaufskontrolle wichtig ist.

Summary

Diabetic neuropatic osteoarthropathy (DNOAP, Charcot joint disease) is a noninfective arthropathy in a well-perfused, insensitive and biomechanical altered foot. Although DNOAP occurs in various sensomotoric neuropathies, diabetes mellitus is the most common cause. The pathogenesis remains still uncertain. During the course of disease bone and joint destruction, fragmentation, and remodelling can develop. In patients presenting with a warm, swollen and only slightly painful foot, DNOAP should be concidered. Plain radiography is adequate to make the diagnosis, but magnetic resonance imaging can be helpful to exclude osteomyelitis. The treatment of DNOAP depends on the stage of the disease. Patients with a history of Charcot joint disease are at high risk of future foot problems, and careful follow- up is mandatory.

Schlüsselwörter

Diabetisch neuropathische Osteoarthropathie - Charcot-Fuß - Diabetes mellitus - Druckentlastung

Keywords

Diabetic neuropathic arthropathy - Charcot joint disease - diabetes mellitus - offloading

^* Die Autoren haben einen gleichen Anteil an der Erstellung des Manuskripts

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