The Essentials of Charcot Neuroarthropathy : Biomechanics, Pathophysiology, and MRI Findings

The Essential Charcot Neuroarthropathy: Biomechanics, Pathophysiology, and MRI Findings provides a comprehensive analysis of Charcot neuroarthropathy (or Charcot Foot) in diabetic patients. All aspects are covered, including epidemiology, biomechanics, pathophysiology, socioeconomic impacts, radiological findings, and differential diagnosis, with an emphasis on MRI. Chapters address the challenges of pre-and-post surgical management of Charcot neuroarthropathy and the role of unconventional imaging modalities in diagnosis. The book presents an analysis of the normal biomechanics of the ankle and foot, the biomechanical derangements of the ankle-foot unit (including abnormal gait) caused by diabetes Type II, and more. Finally, there is also a reference of the pathophysiology of diabetes-induced peripheral neuropathy and its direct link with the development of Charcot neuroarthropathy foot. Diabetes-induced Charcot foot is frequently misunderstood, misinterpreted and misdiagnosed which can lead to confusion and detrimental management with reported high morbidity. Presents a clear differentiation of Charcot neuroarthropathy with other conditions such as osteoarthritis, gout, psoriasis, rheumatoid arthritis, the Madura foot, and others Provides a state-of-art catalogue of all radiological features of Charcot neuroarthropathy with MRI Describes the pre-and post-surgical procedures used for the management of Charcot neuroarthropathy and their socioeconomic impacts Includes MRI color images of soft tissue damages for ease of understanding Cover image Title page Table of Contents Copyright List of contributors Acknowledgments Introduction Chapter 1. Biomechanics of the ankle-foot unit: derangements and radiological signs Abstract 1.1 Basic biomechanics of the normal ankle-foot unit 1.2 The ankle-foot unit: anatomy and structural organization 1.3 The plantar arches of the foot: biomechanical functions 1.4 The gait and gait cycle, normal biomechanics in the gait cycle 1.5 The swing phase 1.6 Muscle involvement in the gait phases, rocker action of the ankle-foot unit 1.7 Gait abnormalities in the diabetic foot 1.8 Biomechanical derangements of the diabetic foot: Charcot joint disease and limitation of joint motility 1.9 Plantar pressure abnormalities in diabetic peripheral neuropathy 1.10 Diabetic peripheral neuropathy and structural changes in bones, joints, and soft tissues References Chapter 2. Diabetes and Charcot neuroarthropathy: pathophysiology Abstract 2.1 Diabetes: definition and general considerations 2.2 Pathophysiology of diabetes mellitus type 1 and type 2 2.3 Diabetes-induced Charcot neuroarthropathy 2.4 Charcot foot syndrome versus Charcot neuro-osteoarthropathy or Charcot neuropathic-sarco-osteoarthropathy 2.5 Theories of Charcot neuroarthropathy: the German theory and the French theory 2.6 Prevalence of Charcot neuroarthropathy 2.7 Conditions that influence the advent of Charcot neuroarthropathy 2.8 Symmetrical and asymmetrical neuropathy in relation to Charcot neuroarthropathy 2.9 Autonomic neuropathy and neuropathic edema 2.10 Nondiabetic conditions producing Charcot foot or Charcot neuroarthropathy 2.11 Complications of Charcot neuroarthropathy (bones and soft tissues) 2.12 Complications affecting soft tissues 2.13 Signs of remission and recurrence of Charcot neuroarthropathy 2.14 Role of imaging in Charcot neuroarthropathy 2.15 Differential diagnosis or common conditions that resemble Charcot neuroarthropathy 2.16 Prognosis of Charcot neuroarthropathy 2.17 Conclusion References Chapter 3. Epidemiology and socioeconomic impact of diabetes and Charcot neuroarthropathy Abstract 3.1 Introduction 3.2 Diabetes mellitus type 2: epidemiology and prevalence worldwide 3.3 Diabetes mellitus type 2: effect of rapid economic development and modernization 3.4 Prevalence of diabetes mellitus type 2 in some countries 3.5 Common risk factors for diabetes mellitus type 2 complications 3.6 General costs of diabetes mellitus type 2 in the United States 3.7 Diabetes-induced Charcot neuroarthropathy 3.8 Risk factors for Charcot neuroarthropathy 3.9 Foot ulcerations in Charcot neuroarthropathy 3.10 Infection 3.11 Cost of foot ulceration 3.12 Foot amputation in Charcot neuroarthropathy 3.13 Depression, anxiety, dementia, and sexual dysfunction in Charcot neuroarthropathy 3.14 Life expectancy and mortality in Charcot neuroarthropathy 3.15 Conclusion References Chapter 4. Charcot neuroarthropathy: historical analysis and characteristics Abstract 4.1 Charcot neuroarthropathy (the diabetic foot): definition and characteristics 4.2 Historical perspectives of Charcot neuroarthropathy 4.3 Epidemiology, incidence, prevalence, and ethnicity of diabetic foot disease 4.4 Risk factors and disorders producing the Charcot Foot 4.5 Development and presentation of Charcot neuroarthropathy: the theories (acute inflammation theory and neurotraumatic and neurovascular theory) and predisposing factors 4.6 Clinical presentation and distribution of Charcot involvement and the concept of “vicious cycle” and equinus deformity of the Charcot foot 4.7 Stages of Charcot neuroarthropathy 4.8 Classifications of Charcot neuroarthropathy based on anatomic locations: a meta-analysis 4.9 New classification: a proposed classification based on anatomy, biomechanics, and magnetic resonance imaging findings in bones and soft tissues References Chapter 5. Normal bone, bone deformity, and joint dislocation in Charcot neuroarthropathy Abstract 5.1 Normal bone: infrastructure and biomechanical properties of bone 5.2 Biomechanical properties of bone 5.3 Loading and off-loading of the ankle-foot unit: generalities 5.4 Loading and off-loading of the foot in diabetes 5.5 Pathomechanics of the midfoot: mechanism of bone deformity 5.6 Joint dislocations in Charcot neuroarthropathy 5.7 Diagnostic imaging 5.8 Complications of Lisfranc dislocation 5.9 Toe deformities 5.10 Second ray syndrome References Chapter 6. Biomechanical behavior of bone. Fractures in Charcot neuroarthropathy Abstract 6.1 The normal bone: biomechanical characteristics 6.2 Bone elasticity: cortical bone versus trabecular bone 6.3 Biomechanical behavior of bone: role of the bone matrix 6.4 Muscular activity and effects on bone 6.5 Bone geometry and effects on biomechanical behavior 6.6 Bone changes with aging: deterioration of intrinsic and extrinsic resistance 6.7 Changes in trabecular bone with aging 6.8 Bone remodeling: mechanism and characteristics 6.9 Diabetes type 2: effects on bone infrastructure 6.10 Fractures of the ankle–foot unit in diabetes mellitus 6.11 Stress fractures of the ankle–foot unit 6.12 DMT2 therapeutics and effects on bones References Further reading Chapter 7. Osteomyelitis in Charcot neuroarthropathy Abstract 7.1 Osteomyelitis: definition and history 7.2 Osteomyelitis: clinical characteristics and risk factors 7.3 Ulceration and osteomyelitis 7.4 Diagnosis of osteomyelitis in Charcot neuroarthropathy 7.5 Osteomyelitis versus Charcot neuroarthropathy 7.6 Osteomyelitis: generalities and pathogenesis in diabetes-related Charcot neuroarthropathy 7.7 Imaging of osteomyelitis in Charcot neuroarthropathy References Chapter 8. Differential diagnosis in Charcot neuroarthropathy Abstract 8.1 Introduction 8.2 Common inflammatory conditions that resemble Charcot neuroarthropathy 8.3 Rheumatoid arthritis and Charcot neuroarthropathy 8.4 Osteoarthritis, diabetes, and Charcot neuroarthropathy 8.5 Gout and Charcot neuroarthropathy 8.6 Psoriasis arthritis and Charcot neuroarthropathy 8.7 Pseudogout and Charcot Neuroarthropathy 8.8 Infectious conditions that resemble diabetes-induced Charcot neuroarthropathy 8.9 Human immunodeficiency virus infection and Charcot neuroarthropathy 8.10 Nondiabetic conditions with underlying neurogenic arthropathy 8.11 Covid-19 infection and diabetes References Further reading Chapter 9. The articular cartilage: biomechanics and damage in diabetes-induced Charcot neuroarthropathy Abstract 9.1 Introduction 9.2 Articular cartilage: function, composition, and structure 9.3 Biomechanical behavior of articular cartilage 9.4 Biomechanics of cartilage degeneration 9.5 Metabolism of the cartilage: role of the chondrocytes 9.6 The link between diabetes and osteoarthritis 9.7 Risk factors for diabetes mellitus type 2 and osteoarthritis 9.8 Effects of diabetes mellitus type 2 and hyperglycemia on cartilage 9.9 Effects of diabetes mellitus type 2 and hyperglycemia on tendons and ligaments 9.10 Relevance of the triad: diabetes, arthritis, and obesity 9.11 Diabetes, osteoarthritis, and subchondral bone lesion 9.12 Diabetes and association with loss of cartilage and impairment of fracture repair 9.13 Magnetic resonance imaging of articular cartilage References Chapter 10. The skin: anatomy and pathologies in diabetes Abstract 10.1 Introduction 10.2 Layers of the skin 10.3 Blood supply to the skin of ankle and foot 10.4 Innervation of the skin of the ankle-foot unit 10.5 Skin diseases in diabetes: prevalence and pathogenesis 10.6 Skin ulceration 10.7 Sinus tracts 10.8 Diabetic blisters (bullosis diabeticorum) 10.9 Callus and corns 10.10 Skin xerosis 10.11 Eruptive xanthomatosis 10.12 Madura foot (mycetoma) References Further reading Chapter 11. Plantar subcutaneous fat pad and Kager fat pad and changes in Charcot neuroarthropathy Abstract 11.1 The foot fat pads: generalities 11.2 The plantar fat pad: function, anatomy, and histology 11.3 Biomechanics of the plantar fat pad 11.4 Plantar fat pad and pressure distribution 11.5 Plantar fat pad atrophy: causes and pathophysiology 11.6 Effects of diabetes and hyperglycemia on the plantar fat tissue 11.7 The calcaneal fat pad 11.8 Diabetes mellitus type 2-related lesions in the plantar fat pad 11.9 The Kager fat pad References Chapter 12. The plantar aponeurosis: anatomy, pathomechanics, imaging, and pathologies related to Charcot neuroarthropathy Abstract 12.1 The plantar aponeurosis: anatomy 12.2 MR anatomy of the plantar aponeurosis: relationship with adjacent structures 12.3 Pathomechanics of plantar aponeurosis 12.4 Pathologies of plantar aponeurosis in relation with diabetes and Charcot neuroarthropathy 12.5 Plantar fibromatosis References Chapter 13. The intrinsic and extrinsic muscles: anatomy and pathologies in diabetes-related Charcot neuroarthropathy Abstract 13.1 The intrinsic plantar foot muscles 13.2 The extrinsic muscles 13.3 Pathomechanics of the foot muscles 13.4 Pathologies of the muscles in diabetes-related Charcot neuroarthropathy 13.5 Conclusion References Further reading Chapter 14. The Achilles tendon: anatomy biomechanics and changes in Charcot neuroarthropathy Abstract 14.1 Introduction 14.2 Achilles tendon anatomy 14.3 Biomechanics of the Achilles tendon 14.4 Pathologies of the Achilles tendon References Chapter 15. The tendons and ligaments of the ankle-foot unit, the tarsal tunnel, the sinus tarsi, fascial compartments of the ankle-foot unit, and changes seen in Charcot neuroarthropathy Abstract 15.1 Introduction 15.2 The tendons of the ankle-foot unit 15.3 Imaging considerations 15.4 Tendon pathology (tendinosis, tear, and tenosynovitis) 15.5 Pathophysiology of tendon disease in diabetes and Charcot neuroarthropathy 15.6 Tendinosis 15.7 Tenosynovitis 15.8 Tendon rupture 15.9 The ligaments of the ankle-foot unit 15.10 The tarsal tunnel 15.11 The sinus tarsi 15.12 Fascial compartments of the ankle-foot unit References Further reading Chapter 16. The synovium and bursae of the ankle-foot unit: anatomy and pathologies in Charcot neuroarthropathy Abstract 16.1 The synovium 16.2 The synovial joints and the functions of the synovium 16.3 The synovium and the tendon: functions of the synovium 16.4 Pathologies of the synovium at the ankle-foot unit 16.5 The bursa 16.6 Pathology of the bursa: imaging References Further reading Chapter 17. The vascular system of the ankle-foot unit: anatomy and pathologies in Charcot neuroarthropathy Abstract 17.1 Anatomy of the vascular system of the ankle-foot unit 17.2 Pathologies of the vascular system 17.3 Role of imaging in peripheral arterial disease 17.4 Monckeberg’s arteriosclerosis 17.5 Muscle infarction in diabetic foot 17.6 Necrosis in Charcot neuroarthropathy References Chapter 18. The nervous system: innervations of the skeleton; bone homeostasis; and peripheral neuropathies (Baxter’s neuropathy, tarsal tunnel syndrome, and peroneal neuropathy) Abstract 18.1 Introduction 18.2 The nervous system and innervations of the skeleton 18.3 The peripheral nervous system: somatic innervation of bones 18.4 Peripheral nervous system: autonomic (sympathetic and parasympathetic) innervation of bones 18.5 Characteristics of the skeleton and regulation of bone homeostasis 18.6 Autonomic innervation of the bone marrow 18.7 The bone marrow niche 18.8 Clinical relevance of diabetic autonomic neuropathy 18.9 Diabetic peripheral neuropathy and bone disease 18.10 Influence of the peripheral nervous system on bone growth, fracture healing, denervation, and heterotopic bone formation 18.11 Pathophysiology of bone pain 18.12 Peripheral neuropathies of ankle-foot unit: Baxter’s neuropathy, tarsal tunnel syndrome, and peroneal neuropathy 18.13 Peroneal neuropathies 18.14 Conclusion References Chapter 19. The surgical management of the Charcot foot: physical examination of the foot prior to surgery, indications and criteria for amputation, and surgical techniques Abstract 19.1 Examination of the Charcot neuropathic foot 19.2 Current conservative management of Charcot neuropathic foot 19.3 Indications and criteria for surgery 19.4 Current surgical management of Charcot neuropathic foot 19.5 Amputation 19.6 Conclusion References Chapter 20. The operated Charcot foot: biomechanics of the operated foot and foot ulcerations and their management Abstract 20.1 Biomechanics of the operated foot 20.2 Ulcerations: management and follow-up 20.3 Preventive measures for Charcot foot deformity: the role of footwear 20.4 Complications of the deformed Charcot foot 20.5 Surgical management of the deformed Charcot foot: rehabilitation 20.6 Psychosocial implications of the Charcot foot References Chapter 21. The surgical approach and follow-up of the complicated Charcot foot: general considerations Abstract 21.1 Physical examination of the Charcot neuroarthropathic foot (diabetic foot) 21.2 Classifications 21.3 Current conservative management of Charcot neuropathic foot, diabetic foot infections, and preventative measures for skin ulcerations 21.4 Risk factors for diabetic foot ulcers 21.5 Indications and criteria for surgery and amputation 21.6 Surgical management of the infected diabetic foot and surgical techniques and prognosis 21.7 Surgical management of the deformed Charcot foot: postsurgical recovery and rehabilitation 21.8 Future nonoperative developments and surgical techniques 21.9 Imaging techniques 21.10 Diabetic foot ulcers: new debridement methods and wound healing strategies References Further reading Chapter 22. Imaging modalities in Charcot neuroarthropathy: indications and usefulness Abstract 22.1 Introduction 22.2 Radiography: indications 22.3 Ultrasonography: indications in Charcot neuroarthropathy 22.4 Computed tomography: indications in Charcot neuroarthropathy 22.5 Nuclear medicine: use in Charcot neuroarthropathy 22.6 Magnetic resonance imaging in Charcot neuroarthropathy 22.7 Magnetic resonance imaging: protocol and indications References Chapter 23. Considerations of different imaging techniques in the evaluation of Charcot neuroarthropathy (MR spectroscopy, MR diffusion tensor imaging-tractography, MR elastography, and positron emission tomography/magnetic resonance imaging) Abstract 23.1 Introduction 23.2 Ultrasonography (Doppler, tractography) in Charcot neuroarthropathy 23.3 Dual-energy spectral computed tomography and positron emission tomography computed tomography in Charcot neuroarthropathy 23.4 Nuclear imaging in Charcot neuroarthropathy 23.5 Advanced MR techniques in Charcot neuroarthropathy 23.6 Magnetic resonance imaging of skeletal muscle: qualitative and quantitative techniques (MR spectroscopy, MR diffusion tensor imaging-tractography, MR elastography, and positron emission tomography/magnetic resonance imaging) 23.7 Areas of research needed in the future References Index