Download - Perc. Pantalar Fusion
![Page 1: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/1.jpg)
Pan-talar Arthrodesis for Charcot's Arthropathy of the
ankle withLocalized osteoporosis
Ahmed Kholeif MD
![Page 2: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/2.jpg)
Charcot Neuroarthropathy
Charcot Neuroarthropathy Background Originally described
in 1868 by Jean Martin Charcot
Patients with tabes dorsalis
Massive joint destruction, subluxation and dislocation was seen
![Page 3: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/3.jpg)
Charcot Neuroarthropathy
Charcot - Background Predisposing conditions:
diabetes mellitus alcoholism syringomyelia spinal cord lesions and others
Today, most common in diabetics, commonly in the lower extremity
![Page 4: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/4.jpg)
Charcot Neuroarthropathy
Charcot Foot Radiographic
hallmarks: Localized
osteoporosis Bony destruction,
fragmentation Bony remodeling Joint destruction,
subluxation and dislocation
![Page 5: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/5.jpg)
Charcot Neuroarthropathy
Charcot and Diabetes Mellitus
Average disease history of 10-12 years or more
Generally poor blood sugar control Reported incidence varies widely
in literature, from 0.08-0.5% up to 16% of diabetics
![Page 6: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/6.jpg)
Charcot Neuroarthropathy
Pathogenesis
Has yet to be fully elucidated Sensory and autonomic neuropathy
nearly universally present Arteriovenous shunting thought to play
a role Normal blood supply and hyperglycemia
also seen Repetitive microtrauma may be inciting
factor
![Page 7: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/7.jpg)
Charcot Neuroarthropathy
Pathogenesis Two theories…
neurotraumatic (German)
neurovascular (French)
![Page 8: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/8.jpg)
Charcot Neuroarthropathy
PathogenesisNeurotraumatic Theory Loss of neuro-protection causing
repetitive microtrauma.
This trauma can lead to intracapsular effusions, ligamentous laxity and joint instability
![Page 9: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/9.jpg)
Charcot Neuroarthropathy
PathogenesisNeurotraumatic Theory
absence of protective sensation allows continued loading of fractured extremity
heightened healing response seen
![Page 10: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/10.jpg)
Charcot Neuroarthropathy
Pathogenesis- Neurovascular Theory
Increased peripheral blood flow resulting from autonomic sympathectomy
Autonomic sympathectomy produces a failure of the normal regulatory mechanisms that control blood flow
![Page 11: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/11.jpg)
Charcot Neuroarthropathy
Pathogeneis- Neurovascular Theory
autonomic dysfunction causes arteriovenous shunting and vasodilitation
increases rate of blood flow to extremity
correlated with increased osteoclastic activity resulting in bone resorption and fragmentation.
![Page 12: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/12.jpg)
Charcot Neuroarthropathy
Pathogenesis- Neurovascular Theory
marked demineralization of bone increases susceptibility to
subluxation, fracture and collapse
![Page 13: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/13.jpg)
Charcot Neuroarthropathy
Pathogenesis
today, most agree that both theories play a role in charcot
combination of localized osteoporosis, bone hyperemia, joint instability and sensorimotor deficits predisposes to changes seen with charcot
![Page 14: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/14.jpg)
Charcot Neuroarthropathy
Anatomical Classification (Brodsky) Type 1: Tarso-metatarsal joint (70%). Type 2: Midtarsal & Subtalar joints
(20%). Type 3: (3 a) Ankle joint. (3 b) Avulsion of Tendo-achillis
(10%)
![Page 15: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/15.jpg)
Charcot Neuroarthropathy
Anatomical Classification (Brodsky)
![Page 16: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/16.jpg)
Type 1: Tarsometatarsal Joints:
![Page 17: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/17.jpg)
Type 2: Chopart’s (Transverse Tarsal) and Subtalar Joints:
![Page 18: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/18.jpg)
Type 3A: Ankle:
![Page 19: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/19.jpg)
Type 3B: Posterior Calcaneus:
![Page 20: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/20.jpg)
Type 4: Multiple Regions:
![Page 21: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/21.jpg)
Type 5: Forefoot:
![Page 22: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/22.jpg)
Charcot Neuroarthropathy
Radiographic Staging (Eichenholtz, 1966)
I Developmental (acute) stage
II Coalescence (quiescent) stage
III Consolidation (resolution) stage
![Page 23: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/23.jpg)
Charcot Neuroarthropathy
Eichenholtz Classification
Stage I - Developmental (acute)
Hyperemia due to autonomic neuropathy weakens bone and ligaments
Diffuse swelling, joint laxity, localized osteopenia, subluxation, frank dislocation, fine periarticular fragmentation, debris formation
![Page 24: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/24.jpg)
Charcot Neuroarthropathy
Radiographs Stage I
![Page 25: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/25.jpg)
Charcot Neuroarthropathy
Radiographs Stage I
![Page 26: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/26.jpg)
Charcot Neuroarthropathy
Eichenholtz Classification
Stage II - Coalescence (quiescent)
Absorption of osseous debris, fusion of larger fragments
Dramatic sclerosis Joints become less mobile and more stable Aka the “hypertrophic”, or “subacute”
phase of Charcot
![Page 27: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/27.jpg)
Charcot Neuroarthropathy
Radiographs Stage II
![Page 28: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/28.jpg)
Charcot Neuroarthropathy
Radiographs Stage II
![Page 29: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/29.jpg)
Charcot Neuroarthropathy
Eichenholtz Classification Stage III - Consolidation
(resolution)
Osseous remodeling for clinical purposes, stage I is
regarded as the acute phase, while stages II and III are regarded as the chronic or quiescent phase
![Page 30: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/30.jpg)
Charcot Neuroarthropathy
Radiographs Stage III
![Page 31: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/31.jpg)
Charcot Neuroarthropathy
Clinical Presentation Red, hot, swollen foot Typically painless or only mildly
painful unilateral swelling of extremity
Can mimic cellulitis, gout, osteomyelitis and even DVT
Plain films may appear normal initially
![Page 32: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/32.jpg)
Charcot Neuroarthropathy
Clinical Presentation Ortho exam may reveal joint
hypermobility with crepitus +/- cutaneous ulceration
As disease progresses, longitudinal and transverse arches of foot may collapse, creating a rocker bottom foot
![Page 33: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/33.jpg)
Charcot Neuroarthropathy
Clinical Presentation Some degree of sensory deficit
always present Deep tendon reflexes, vibratory
sensation, and proprioception may be diminished or absent
Due to autonomic sympathectomy, may see bounding pulses, calor, rubor, tumor and anhidrosis +/- xerosis
![Page 34: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/34.jpg)
Charcot Neuroarthropathy
Clinical Presentation Acute
presentation
![Page 35: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/35.jpg)
Charcot Neuroarthropathy
Clinical Presentation Rocker bottom
foot
![Page 36: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/36.jpg)
Charcot Neuroarthropathy
Clinical Presentation Rocker bottom
foot
![Page 37: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/37.jpg)
Clinical Presentation
Charcot Neuroarthropathy
![Page 38: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/38.jpg)
Clinical Presentation
Charcot Neuroarthropathy
![Page 39: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/39.jpg)
Charcot Neuroarthropathy
Treatment Primary goals
Stability, plantigrade foot, and to keep the foot free of ulceration
Selection of treatment plan Phase dependent, location, severity,
and the +/- of ulceration Conservative vs. Surgical
![Page 40: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/40.jpg)
Charcot Neuroarthropathy
Treatment Initially consists of immobilization
during acute phase to prevent disease progression (adds to risk of osteopenia)
Generally via total contact casting Some disagreement in the literature as
to whether or not to permit any weight bearing during this time
Others: Pneumatic Walker brace, etc.
![Page 41: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/41.jpg)
Charcot Neuroarthropathy
Total Contact Cast Permits
ambulation while uniformly distributing weight bearing pressures over the entire foot surface
![Page 42: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/42.jpg)
Charcot Neuroarthropathy
Treatment After acute phase has passed, long-term
or permanent bracing is often needed Gradual return to protected weight
bearing Examples: Charcot Restraint Orthotic
Walker (CROW), patellar tendon-bearing braces, custom-molded shoes, AFO, etc.
![Page 43: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/43.jpg)
Charcot Neuroarthropathy
Patellar Tendon-Bearing Brace Used to transfer
weight bearing forces from the orthosis through the patellar tendon, thereby decreasing weight bearing forces through the foot and ankle
![Page 44: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/44.jpg)
Surgical Treatment of Charco’s AnkleWhat you do not want to see
Charcot Neuroarthropathy
![Page 45: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/45.jpg)
Surgical Treatment of Charcot’s AnkleWhat you do not want to see
Charcot Neuroarthropathy
![Page 46: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/46.jpg)
Charcot Neuroarthropathy
Surgical Treatment ONLY considered after all
conservative measures exhausted Surgical intervention is necessary
in some cases of continued ulceration, gross instability, presence of infection, limb shortening and difficulty in shoe wear.
![Page 47: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/47.jpg)
Charcot Neuroarthropathy
Surgical Treatment Very patient dependent Ostectomy, arthrodesis, midtarsus
closing wedge osteotomy, external fixation
![Page 48: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/48.jpg)
Indications for surgery in the Charcot ankle:
1. Acute dislocation
2. Recurrent ulceration
3. Secondary to either instability or bony prominence
4. Severe or uncontrolled deformity
![Page 49: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/49.jpg)
Surgical procedures for Charcot Ankle
1. Debridement of Ulcer.
2. Ostectomy.
3. Arthrodesis with Internal Fixation.
4. Arthrodesis with External Fixation.
5. Amputation.
![Page 50: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/50.jpg)
Methods of fixation (arthrodesis):
Arthrodesis with Internal Fixation:
1. Arthrodesis with Plate and Screws.2. Arthrodesis with Nail.3. Arthrodesis with Steinmann pin.4. Arthrodesis with cannulated
screws
![Page 51: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/51.jpg)
Arthrodesis with plate & screws
Charcot Neuroarthropathy
![Page 52: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/52.jpg)
Important factors for success include:
1. Careful removal of all cartilage and debris,
2. Debridement to bleeding subchondral bone,
3. Meticulous fashioning of bone surfaces for contact,
4. Complete debridement of all synovial and
scarred capsule, stable internal fixation and
grafting.
![Page 53: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/53.jpg)
2. Arthrodesis with nail:
Intramedullary fixation for arthrodesis of
the ankle was described by Adams in
1948.
The goal of treatment with intramedullary
fixation is to obtain alignment of the
ankle -foot system, reducing significantly
the risk of ulceration.
![Page 54: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/54.jpg)
Method for estimating insertion site for retrograde intramedullary fixation :
![Page 55: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/55.jpg)
Arthrodesis with nail:
![Page 56: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/56.jpg)
3. Arthrodesis with A Steinmann pin:
Successful arthrodesis may be
achieved with a Steinmann pin from
the heel across the subtalar joint.
![Page 57: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/57.jpg)
Arthrodesis with A Steinmann pin:
![Page 58: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/58.jpg)
Arthrodesis with external fixation:
External fixation is a viable alternative that
allows micromotion to occur through
fracture.
External fixation should be strongly
considered as the best choice of fixation
when addressing the multiple degenerative
areas of Charcot disease.
![Page 59: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/59.jpg)
![Page 60: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/60.jpg)
![Page 61: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/61.jpg)
Arthrodesis with Multiple Cannulated Screws
Minimally Invasive Lower incidence of infection Stable fixation specially in
resorbed talus Early rehabilitation with bracing
Charcot Neuroarthropathy
![Page 62: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/62.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 63: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/63.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 64: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/64.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 65: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/65.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 66: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/66.jpg)
Charcot Neuroarthropathy
![Page 67: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/67.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 68: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/68.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 69: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/69.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 70: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/70.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 71: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/71.jpg)
Arthrodesis with multiple cannulated screws
Charcot Neuroarthropathy
![Page 72: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/72.jpg)
Charcot Neuroarthropathy
Medical Treatment Bone mineral density alterations
have been documented in Charcot patients Example: localized osteopenic
changes Increasing interest in the use of
bisphosphonates
![Page 73: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/73.jpg)
Charcot Neuroarthropathy
Bisphosphonates Pyrophosphate analogs that inhibit
osteoclastic bone resorption Used commonly in diseases
characterized by abnormal bone turnover Example: Paget’s disease, osteoporosis,
osteolytic bone metastasis, Gorham-Stout disease and others
![Page 74: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/74.jpg)
Charcot Neuroarthropathy
Pamidronate Most commonly used bisphosphonate
is pamidronate, a second generation bisphosphonate
Acts by adsorbing onto hydroxyapatite crystals in newly synthesized bone matrix, blocking access of osteoclast precursors to this matrix and inhibiting bone resorption
![Page 75: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/75.jpg)
Charcot Neuroarthropathy
Bisphosphonates Benefit of inhibiting bone resorption while not
significantly inhibiting bone remineralization
Presently, only bisphosphonates have been demonstrated to have some benefit in patients with Charcot Neuroarthropathy
Bisphosphonates may have potential disadvantages in that they decrease bone remodeling and are contraindicated in patients with renal insufficiency
![Page 76: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/76.jpg)
Intranasal Calcitonin Intranasal Calcitonin in the Treatment of
Acute Charcot Neuroosteoarthropathy
A randomized controlled trial Robert Bem, MD1, Alexandra Jirkovská, MD, PHD1, Vladimíra
Fejfarová, MD1, Jelena Skibová1 and Edward B. Jude, MD, FRCP2
Suggests that intranasal calcitonin treatment of acute CNO, including patients with renal insufficiency, could be an effective modality to prevent bone resorption and progression of this condition, although larger clinical trials are needed to assess the role of calcitonin in patients with acute CNO
Charcot Neuroarthropathy
![Page 77: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/77.jpg)
Charcot Neuroarthropathy
Conclusions Charcot a potentially devastating
sequela of diabetes mellitus Treatment requires careful initial
management and long-term follow-up Conservative, surgical treatment
options can be augmented with the pharmacologic use of bisphosphonates
![Page 78: Perc. Pantalar Fusion](https://reader034.vdocument.in/reader034/viewer/2022052301/544a2072af79594d088b461b/html5/thumbnails/78.jpg)
Charcot Neuroarthropathy
Thank You