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Charcots fot, diabetesfot

Sist oppdatert: Sist revidert:
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Definisjon:
Charcots fot er en osteoartropati eller nevroartropati som er en komplikasjon ved diabetes med perifer sensorisk og sensomotorisk nevropati
Forekomst:
Prevalens samlet 0,79%, for diabetes type 1 1,97% i Sverige i 2016
Symptomer:
I tidlig stadium ensidig varm, rød, hoven fot hos pasient med diabetisk nevropati. Ofte patologiske frakturer og dislokasjon av fotledd. Kan ende med deformitet. 
Funn: 
Nevropati. Ensidig rubor, feilstillinger i fot. 
Diagnostikk:
MR gir den beste bildemessige fremstillingen av endringene
Behandling:
Klinisk mistanke om Charcots fot bør straks føre til henvisning til fotterapeutisk team for avlastning i ortose eller gips, senere ev. kirurgi
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  2. Tsatsaris G, Ekberg NR, Fall T, Catrina S. Prevalence, incidence and risk factors for Charcot foot in patients with diabetes: a nationwide Swedish study. Abstract. EASD september 2022
  3. Armstrong DG, Todd WF, Lavery LA et al. The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic. Diabet Med 1997; 14: 357-63. PubMed  
  4. Petrova NL, Foster AV, Edmonds ME. Calcaneal bone mineral density in patients with Charcot neuropathic osteoarthropathy: differences between Type 1 and Type 2 diabetes. Diabet Med 2005; 22: 756-61. PubMed  
  5. Jeffcoate WJ, Game F, Cavanagh PR. The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet 2005; 366: 2058-61. PubMed  
  6. Rajbhandari SM, Jenkins RC, Davies C et al. Charcot neuroarthropathy in diabetes mellitus. Diabetologia 2002; 45: 1085-96. PubMed  
  7. Chantelau E, Poll LW. Evaluation of the diabetic charcot foot by MR imaging or plain radiography - an observational study. Exp Clin Endocrinol Diabetes 2006; 114: 428-31. PubMed  
  8. Jones KB, Maiers Yelden KA, Marsh JL et al. Ankle fractures in patients with diabetes mellitus. J Bone Joint Surg Br 2005; 87: 489-95. PubMed  
  9. Holstein P, Lohmann M, Bitsch M et al. Achilles tendon lengthening, the panacea for plantar forefoot ulceration? Diabetes Metab Res Rev 2004; 20: 37-40. PubMed  
  10. Wukich DK, Sung W, Wipf SA, Grimaldi A. The consequences of complatency: managing the effects of unrecognized Charcot feet. Diabet Med 2011; 28: 195-8. PubMed  
  11. Crawford F, Cezard G, Chappell FM, et al. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technology Assessment, No. 19.57. 2015. legehandboka.no  
  12. Fabrin J, Larsen K, Holstein PE. Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care 2000; 23: 796-800. PubMed  
  13. Larsen K, Fabrin J, Holstein PE. Incidence and management of ulcers in diabetic Charcot feet. J Wound Care 2001; 10: 323-8. PubMed  
  14. Chantelau E, Richter A, Schmidt Grigoriadis P et al. The diabetic charcot foot: MRI discloses bone stress injury as trigger mechanism of neuroarthropathy. Exp Clin Endocrinol Diabetes 2006; 114: 118-23. PubMed  
  15. Termaat MF, Raijmakers PGHM, Scholten HJ et al. The accuracy of diagnos-tic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87: 2464-71. PubMed  
  16. Helsedirektoratet. Nasjonal faglig retningslinje for diabetes. Oslo; Helsedirektoratet 2019. helsedirektoratet.no  
  17. Pinzur MS, Lio T, Posner M. Treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast. Foot Ankle Int 2006; 27: 324-9. PubMed  
  18. Fabrin J, Larsen K, and Holstein PE. Arthrodesis with external fixation in the unstable or misaligned Charcot ankle in patients with diabetes mellitus. Int J Low Extrem Wounds 2007; 6: 102-7. PubMed  
  19. Pelton K, Hofer JK, Thordarson DB. Tibiotalocalcaneal arthrodesis using a dynamically locked retrograde intramedullary nail. Foot Ankle Int 2006; 27: 759-63. PubMed  
  20. Jolly GP, Zgonis T, Polyzois V. External fixation in the management of Charcot neuroarthropathy. Clin Podiatr Med Surg 2003; 20: 741-56.
  21. Hastings MK, Sinacore DR, Fielder FA et al. Bone mineral density during total contact cast immobilization for a patient with neuropathic (Charcot) arthropathy. Phys Ther 2005; 85: 249-56. PubMed  
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Eivind Witsø, seksjonsoverlege dr.med., Seksjon for ortopediske infeksjoner og amputasjoner, St. Olavs Hospital, Trondheim