THE CHARCOT’S SYNDROME. APPEARANCE AND TREATMENT.

The Charcot’s syndrome is a degenerative peripheral neuropathy, chronic and progressive which affects to one or more peripheral joints. The pathology develops by a lack of normal sensory and nociceptive proprioception in the innervations of foot and ankle joints. The Diabetes Mellitus, with a high level of glycemia in blood kept in time, causes two of the reasons for the appearance of the neuropathy: nervous lesion and anomalies in the vascular circulation. Nevertheless, there are other systemic conditions which can cause it as a peripheral neuropathy. Often, as a result of this sensorial loss and its respective damage of blood vessels, the joints of foot are subjected to traumatisms and repetitive lesions, originating a neurotraumatic effect which hurts progressively, joints, ligaments, cartilages and bones. It is fundamental in order to avoid amputations, the early detection and the commencement of the Charcot’s syndrome. Therefore, it is imperative to establish a strict control of risk patients and to examine the first signs of arthropathy among people with diabetes, beginning with the training of the patient for inspection, suitable  daily attention, and an exhaustive control of glycemia. The development of Charcot’s syndrome can take place in a matter of weeks or months, with origin on a minor trauma connected to the loss of the pain perception and position of place of foot, to repetitive lesions in one or more joints, causing fragmentation and destruction. The initial symptoms can be: slight pain, edema, erythema, increase of local temperature and articular instability. On subsequent stages: dislocations and deformation of foot and ankle, collapse of midfoot (flatfoot and rocker foot) and deformation of toes. The anomalous pressure caused by deformities can originate lesions or ulcers which, due to numbness, use to grow bigger and deep, before being detected. Moreover, if glycemia is not checked, there are more possibilities of infection and more difficulty to combat it. The best treatment is a good prevention of complications. First of all, it is advisable the rest of the affected extremity, unloading in this way the weight in the limb during the acute stage of the disease in order to avoid fractures and ulcers. The immobilization will have to be checked periodically on the basis of the edema, the erythema and the temperature. The acute treatment will consist of putting the foot and ankle in plaster with the aim of diminishing the inflammation and protecting bones. The surgical treatment is reserved for osseous deformities, which involve more risk of ulcers for the patient or in unstable fractures and dislocations which require to solder effectively such pathologies. Once the acute stage is finished, it will be important the use of appropriate shoes, as well as plantar supports in order to avoid points of excess load which can bring about us the appearance of ulcers.

Affectation of the external radii of foot with Charcot’s syndrome.