Cellier Nicolas
EFORT Open Rev. 2025 Jun 2;10(6):327-335. doi: 10.1530/EOR-2025-0057.
Charcot neuroarthropathy is the most severe complication of the diabetic foot. Its diagnosis is difficult and often overlooked, delaying management, with sometimes disastrous consequences. Its incidence is increasing due to the rapid global rise in the number of people with diabetes. Its pathophysiology remains unclear, although the activation of the RANK/RANK-L system appears to be involved, triggered either by neurotraumatic or neurovascular mechanisms, leading to the differentiation of monocytes into osteoclasts. Diagnosis relies on clinical and radiological arguments, particularly MRI. There are different types of Charcot foot depending on the evolution, according to Eichenholtz's classification and based on location according to Sanders and Brodsky's classifications. Treatment involves a multidisciplinary approach with diabetes management and addressing other general complications. Medical treatment is indicated as the first line, with offloading and immobilisation using a 'total contact cast'. In case of failure of this method, or if there is immediate deformity, surgical intervention is indicated, and techniques are evolving rapidly. Depending on the deformity, minimally invasive or arthroscopic procedures may be performed. In cases of significant deformity, foot reconstruction may be proposed, using the so-called 'super construct' technique if necessary. Infection will be treated concurrently or initially, depending on severity. Many complications are reported, but increasingly early and aggressive surgery improves patients' quality of life and reduces amputation rates.
夏科氏神经关节病是糖尿病足最严重的并发症。其诊断困难且常被忽视，导致治疗延误，有时会产生灾难性后果。由于全球糖尿病患者数量迅速增加，其发病率也在上升。尽管RANK/RANK-L系统的激活似乎参与其中，由神经创伤或神经血管机制触发，导致单核细胞分化为破骨细胞，但其病理生理学仍不清楚。诊断依赖于临床和影像学依据，尤其是磁共振成像（MRI）。根据艾肯霍兹的分类，依据桑德斯和布罗德斯基的分类基于部位，夏科氏足有不同的类型。治疗需要多学科方法，包括糖尿病管理及处理其他一般并发症。药物治疗作为一线治疗方法，使用“全接触石膏”进行减负和固定。如果这种方法失败，或者存在即刻畸形，则需进行手术干预，且技术发展迅速。根据畸形情况，可进行微创或关节镜手术。对于严重畸形的病例，如有必要，可采用所谓的“超级构建”技术进行足部重建。根据严重程度，感染将同时或首先进行治疗。虽然报道了许多并发症，但越来越多的早期积极手术改善了患者的生活质量并降低了截肢率。
