tailieunhanh - Diabeticcpg small 2 (Part 5)

Figure 12 Diabetic neuroarthropathy, or Charcot foot, is believed to be a neurologically-mediated complication of diabetes, with the development modified by musculoskeletal stress. The result is osseous fragmentation and joint subluxation with often significant morphologic changes in the architecture of the foot. Complications of the Charcot foot include ulceration under areas of bony prominence and potential amputation often related to infection/osteomyelitis that develops adjacent to the area of ulceration. . | PATHWAY 5 SIGNIFICANT HISTORY Onset of morphologic changes Progressive I static Erythema Swelling Trauma type when repetitive LOPS pain Previous ulcer or Charcot Long-standing diabetes s ra Dermatologic Erythema Warmth Cellulitis Xerosis Ulcer SIGNIFICANT FINDINGS Musculoskeletal Swelling Deformity Joint dislocation Equinus LOPS Autonomic neuropathy Motor neuropathy Absent DTRs Neurologic Vascular Papable pedal pulses Swelling Laboratory tests CBC differential ESR CRP Blood glucose Hb A1c Alkaline phosphatase Bone biopsy Bone culture Treatment of Acute Charcot Restriction of weight-bearing Crutches Wheelchair Immobilization with splint cast or removable cast until hyperemia resolved Continue immobilization 4-6 months until quiescence chronic Charcot Pharmacologic Bone stimulation Radiographic Findings DIAGNOSIS Consider surgical stabilization Foot remains UNSTABLE not responsive to off-I loading immobilization Diagnostic Imaging Plain radiographs Imaging studies CT MRI Bone scan Bone density Joints bones involved Dislocation Osteolysis Soft tissue edema Fractures Vascular calcifications Bone density Deformity Treatment of Chronic Charcot Foot Unstable Bracing Extra depth shoes Custom molded shoes Multiple density insoles Orthoses Foot Stable Supportive measures Therapeutic footwear Patient education Periodicevaluation to prevent recurrence Convert to stable Foot Once quiescent treat as chronic Remains unstable Chronic ulceration Chronic osteomyelitis Consider amputation If ulcer recurs treat appropriately see Pathway 3 DIABETIC FOOT DISORDERS VOLUME 45 NUMBER 5 SEPTEMBER OCTOBER 2006 S-37 Local Inflammatory Process Rank L Musculoskeletal stress Traumatic injury - sprain Structural deformity Obesity Sensory neuropathy Autonomic neuropathy Motor neuropathy Painless Ambulation Ligamentous Laxity Joint Instability Continued weight bearing Joint Subluxation Joint Osseous Fragmentation Figure 12 Diabetic neuroarthropathy or Charcot foot is believed to be a .