Charcot foot

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By: nisandi (45 month(s) ago)

very informative and well prepared presentation. well done

By: acortho (56 month(s) ago)

Slides 35 to 38 from the work of Dr. Nuno crevaro Lopes,Almada, Portugal- Author

Presentation Transcript

NEUROPATHIC FOOT : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC FOOT A.CHANDRASEKARAN MS Ortho., Ph.D., Limb Reconstruction Surgeon, Diabetic foot Reconstruction Surgeon, Professor, Dept of Orthopaedic Surgery, Sri Ramachandra Medical College & Research Institute, Chennai. INDIA.

NEUROPATHIC FOOT : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC FOOT All the bone and joint changes associated with all of the neuropathic arthropathies- Jean-Martin Charcot – Tabes Dorsalis Rapport du congress - 1882

NEUROPATHIC FOOT : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC FOOT Hansen’s Disease Diabetes Post Traumatic Neurological Syringomyelia Meningomyelocoele Congenital Insensitivity to pain Tabes dorsalis Chronic alcoholism

NEUROPATHIC FOOT- PROBLEMS : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC FOOT- PROBLEMS Skin breakdown Repeated ulcers Amputation secondary to resulting deformity and instability Seattle Diabetic foot study, Charles C Saltsman, CORR N 435 p185 – 190 – 2005.

NEUROPATHIC FOOT - PATHOGENESIS : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC FOOT - PATHOGENESIS

NEUROPATHIC FOOT - RISK FACTORS : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC FOOT - RISK FACTORS Destruction of normal anatomy Insensitivity to 5.07mm/ 10gm monofilament Greater body weight h/o ulcers / amputation

NEUROPATHIC FOOT : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC FOOT Clinical presentation varied Localised erythema, increase in temperature swelling, no infection, skin normal, X- Ray normal

CLINICAL PRESENTATIONS : 

22 Mar 2007 acortho@yahoo.co.in CLINICAL PRESENTATIONS

NEUROPATHIC FOOT : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC FOOT Diagnostic study Clinical history Radiograph Radio nucleotide CT/ MRI Bone biopsy and Culture

RADIOLOGICAL FEATURES : 

22 Mar 2007 acortho@yahoo.co.in RADIOLOGICAL FEATURES

CT/MRI : 

22 Mar 2007 acortho@yahoo.co.in CT/MRI

DIABETIC CHARCOTS FOOT- FRYKBERG ANATOMICALCLASSIFICATION : 

22 Mar 2007 acortho@yahoo.co.in DIABETIC CHARCOTS FOOT- FRYKBERG ANATOMICALCLASSIFICATION

FRYKBERG TYPE 1 : 

22 Mar 2007 acortho@yahoo.co.in FRYKBERG TYPE 1

FRYKBERG TYPE 2 : 

22 Mar 2007 acortho@yahoo.co.in FRYKBERG TYPE 2

FRYKBERG TYPE 3 : 

22 Mar 2007 acortho@yahoo.co.in FRYKBERG TYPE 3

FRYKBERG TYPE 3 & 4 : 

22 Mar 2007 acortho@yahoo.co.in FRYKBERG TYPE 3 & 4

FRYKBERG TYPE 5 : 

22 Mar 2007 acortho@yahoo.co.in FRYKBERG TYPE 5

EICHENHOLZ STAGE I : 

22 Mar 2007 acortho@yahoo.co.in EICHENHOLZ STAGE I

EICHENHLOZ STAGE II : 

22 Mar 2007 acortho@yahoo.co.in EICHENHLOZ STAGE II

STAGE III RECURRENT ULCER : 

22 Mar 2007 acortho@yahoo.co.in STAGE III RECURRENT ULCER

DIABETIC CHARCOTS JOINT : 

22 Mar 2007 acortho@yahoo.co.in DIABETIC CHARCOTS JOINT MRI diagnostic

RISK FACTORS AND PREVENTION : 

22 Mar 2007 acortho@yahoo.co.in RISK FACTORS AND PREVENTION

TREATMENT : 

22 Mar 2007 acortho@yahoo.co.in TREATMENT Aim is to prevention and minimisation of foot deformity, joint instability, ulceration, disability and amputation Minimum 6 months follow up required

CONSERVATIVE TREATMENT : 

22 Mar 2007 acortho@yahoo.co.in CONSERVATIVE TREATMENT Non operative -Cast Immobilisation technique -AFO with built in total contact insole rocker bottom outer sole -CROW – Charcot’s Restraint Walker, initial in brace weight bearing -Biphosphonates

ORTHOTICS DEVICES : 

22 Mar 2007 acortho@yahoo.co.in ORTHOTICS DEVICES

OPERATIVE TREATMENT : 

22 Mar 2007 acortho@yahoo.co.in OPERATIVE TREATMENT Operative Ulceration Infection Uncontrolled deformity

TREATMENT : 

22 Mar 2007 acortho@yahoo.co.in TREATMENT 4 TYPES OF SURGERY Deep infection –Debridement Recurrent non infective ulceration from bony prominences – stable feet – exostomy

TREATMENT : 

22 Mar 2007 acortho@yahoo.co.in TREATMENT 3. Recurrent ulceration, uncontrollable deformity - unstable feet – realignment arthrodesis 4. Recurrent limb infection uncontrolled by debridement, IV antibiotics –Transtibial amputation

OSTEOSYNTHESIS : 

22 Mar 2007 acortho@yahoo.co.in OSTEOSYNTHESIS

ILIZAROV RING RECONSTRUCTION : 

22 Mar 2007 acortho@yahoo.co.in ILIZAROV RING RECONSTRUCTION

ILIZAROV RING RECONSTRUCTION : 

22 Mar 2007 acortho@yahoo.co.in ILIZAROV RING RECONSTRUCTION

ILIZAROV RING RECONSTRUCTION : 

22 Mar 2007 acortho@yahoo.co.in ILIZAROV RING RECONSTRUCTION

HANSEN TROPHIC ULCER : 

22 Mar 2007 acortho@yahoo.co.in HANSEN TROPHIC ULCER

NEUROPATHIC ANKLE -ARTHRODESIS : 

22 Mar 2007 acortho@yahoo.co.in NEUROPATHIC ANKLE -ARTHRODESIS

ILIZAROV RING RECONSTRUCTION : 

22 Mar 2007 acortho@yahoo.co.in ILIZAROV RING RECONSTRUCTION

ILIZAROV RING RECONSTRUCTION : 

22 Mar 2007 acortho@yahoo.co.in ILIZAROV RING RECONSTRUCTION

ILIZAROV RING RECONSTRUCTION : 

22 Mar 2007 acortho@yahoo.co.in ILIZAROV RING RECONSTRUCTION

ILIZAROV RING RECONSTRUCTION : 

22 Mar 2007 acortho@yahoo.co.in ILIZAROV RING RECONSTRUCTION

PROBLEMS : 

22 Mar 2007 acortho@yahoo.co.in PROBLEMS Implant failure Non union Residual deformity Pin tract infection

ILIZAROV IN NEUROPATHIC FOOT : 

22 Mar 2007 acortho@yahoo.co.in ILIZAROV IN NEUROPATHIC FOOT Ilizarov ring technology is useful in stabilizing the foot after debridement and helps in healing and aid to prevent amputation in infected Diabetic Charcot's foot

CONCLUSION : 

22 Mar 2007 acortho@yahoo.co.in CONCLUSION Early detection, Conservative Management, Surgical Management when conservative treatment fails. Always try to avoid AMPUTATION

THANK YOU : 

22 Mar 2007 acortho@yahoo.co.in THANK YOU