Varma Ajit Kumar
Professor, Department of Endocrinology, Diabetic Lower Limb and Podiatric Surgery, Amrita Institute of Medical Sciences and Research Center, Ponekkara, Kerala, India.
J Foot Ankle Surg. 2013 Nov-Dec;52(6):740-9. doi: 10.1053/j.jfas.2013.07.001. Epub 2013 Aug 18.
Charcot neuroarthropathy is a limb-threatening, destructive process that occurs in patients with neuropathy associated with medical diseases such as diabetes mellitus. Clinicians' treating diabetic patients should be vigilant in recognizing the early signs of acute Charcot neuroarthropathy, such as pain, warmth, edema, or pathologic fracture in a neuropathic foot. Early detection and prompt treatment can prevent joint and bone destruction, which, if untreated, can lead to morbidity and high-level amputation. A high degree of suspicion is necessary. Once the early signs have been detected, prompt immobilization and offloading are important. Treatment should be determined on an individual basis, and it must be determined whether a patient can be treated conservatively or will require surgical intervention when entering the chronic phase. If diagnosed early, medical and conservative measures only will be required. Surgery is indicated for patients with severe or unstable deformities that, if untreated, will result in major amputations. A team approach that includes a foot and ankle surgeon, a diabetologist, a physiotherapist, a medical social councilor, and, most importantly, the patient and immediate family members is vital for successful management of this serious condition.
夏科氏神经关节病是一种威胁肢体的破坏性病变，发生于患有如糖尿病等内科疾病相关神经病变的患者中。治疗糖尿病患者的临床医生应警惕识别急性夏科氏神经关节病的早期体征，如神经病变足部的疼痛、发热、水肿或病理性骨折。早期发现并及时治疗可预防关节和骨质破坏，若不治疗，可能导致发病和高位截肢。高度怀疑很有必要。一旦发现早期体征，及时固定和减负很重要。治疗应个体化决定，且必须确定患者在进入慢性期时是可采用保守治疗还是需要手术干预。如果早期诊断，仅需药物和保守措施。对于有严重或不稳定畸形、若不治疗将导致大截肢的患者，需进行手术。包括足踝外科医生、糖尿病专家、物理治疗师、医疗社会顾问，以及最重要的患者及其直系亲属在内的团队协作方法，对于成功管理这种严重疾病至关重要。
