Charcot's joints

Last reviewed 07/2021

Neuropathic joints are those damaged because of trauma secondary to the loss of normally protective pain sensation.

They occur in conditions such as tabes dorsalis, syringomyelia, leprosy and diabetes mellitus.

The site of the Charcot joint depends on the localisation of pain loss:

• the ankles and knee joints are the most affected in tabes dorsalis
• in diabetes mellitus, the joints of the tarsus are affected
• the shoulder is involved in syringomyelia
• lower limb involvement occurs in cauda equina lesions

NICE say with respect to Charcot arthropathy and type 1 diabetes (1):

• suspect acute Charcot arthropathy if there is redness, warmth, swelling or deformity (in particular, when the skin is intact), especially in the presence of peripheral neuropathy or renal failure. Think about acute Charcot arthropathy even when deformity is not present or pain is not reported

• to confirm the diagnosis of acute Charcot arthropathy, refer the person within 1 working day to the multidisciplinary foot care service for triage within 1 further working day. Offer non-weight-bearing treatment until definitive treatment can be started by the multidisciplinary foot care service

Reference:

• NICE (August 2015). Diabetic foot problems: prevention and management