Neuropathic joints - often called Charcot joints - are caused by loss of sensation in the joint so that it is severely damaged and disrupted because of trauma secondary to the loss of normally protective pain sensation. (1)
They occur in conditions such as tabes dorsalis, syringomyelia, leprosy and diabetes mellitus.
The site of the Charcot joint depends on the localisation of pain loss:
- the ankles and knee joints are the most affected in tabes dorsalis
- in diabetes mellitus, the joints of the tarsus are affected
- the shoulder is involved in syringomyelia
- lower limb involvement occurs in cauda equina lesions
NICE say with respect to Charcot arthropathy and type 1 diabetes (2):
- suspect acute Charcot arthropathy if there is redness, warmth, swelling or deformity (in particular, when the skin is intact), especially in the presence of peripheral neuropathy or renal failure. Think about acute Charcot arthropathy even when deformity is not present or pain is not reported
- to confirm the diagnosis of acute Charcot arthropathy, refer the person within 1 working day to the multidisciplinary foot care service for triage within 1 further working day. Offer non-weight-bearing treatment until definitive treatment can be started by the multidisciplinary foot care service
Reference
- Varma AK; Charcot neuroarthropathy of the foot and ankle: a review. J Foot Ankle Surg. 2013 Nov-Dec;52(6):740-9
- NICE. Diabetic foot problems: prevention and management. NICE guideline NG19. Published August 2015, last updated October 2019.