3. Blood supply
t
Arterial:
◦ Posterior tibial and dorsalis pedis
supply the foot
Venous:
◦ Deep veins follow the arteries
◦ Superficial veins arise from dorsal
venous arch
4. Nerve supply
The foot is supplied by the (1)
tibial, (2) deep peroneal, (3)
superficial peroneal, (4)sural,
and (5)saphenous
5.
6.
7. CHARCOT FOOT
Named after Jean-Martin Charcot (1868)
Charcot noted this disease process as a complication of syphillis
In 1936, Charcot foot was found to be related to diabetic patients
Pathophysiology:
Neurotraumatic
theory
Neurovascular theoryNeurotraumatic theory:
Unperceive trauma to
insensate foot.
Pt unaware of osseous
destruction occur during
ambulation
Micro trauma leads to
progressive destruction to
bones and joints
Neurovascular theory:
Autonomic neuropathy
causing extremities to
receive increased bloodflow
Results in mismatch in bone
destruction and synthesis,
leading to osteopenia
8. THE FOLLOWING ARE THE
PRINCIPLE PREDISPOSING
DISEASES:
DIABETES
SYRINGOMYELIA
LEPROSY
TABES DORSALIS
11. Presentation:
Vary from mild swelling and no deformity to moderate
deformity with significant swelling
Always presents with signs of inflammation: warmth, joint
effusion, erythema, bone resorption
Pain occurs in > 75% of patients
Instability and loss of joint function; “bags of loose bones”
Amputation Risk (Usually BKA)
Type 100 person-year
Charcot alone 4.1
Ulcer alone 4.7
Charcot + Ulcer Up to 12 times
15. Acute phase:
Immobilization: e.g. Total contact cast (3-6 months)
Reduction of stress
Ideally non-weight bear
PWB with crutches
Post-acute phase: Patient education and foot care
Consider brace e.g. Charcot restraint orthotic walker
Total healing typically takes 1-2 years
16. Surgical therapy:
Based on location of disease, surgeon preferences and
experience with Charcot arthropathy
Surgical procedure include exostosectomy of bony
prominence, osteotomy, arthrodesis, screw and plate fixation,
ORIF, reconstructive surgery, fusion with Achilles tendon
lengthening, autologous bone grafting and amputation.
17. Location Surgery
Ankle with displaced # ORIF
Tibiotalar destruction Arthrodesis
Avascular necrosis of talus Talectomy with tibiocalcaneal fusion
Hindfoot Arthrodesis
Midfoot Correction of rocker-bottom deformity
and osteotomies for bony prominence
Hindfoot/ankle equinus contracture Posterior release/Achilles tendon
leengthening
Forefoot Resection arthroplasty or cheilectomy
19. The Diabetic Foot may be defined as a group of
syndromes in which neuropathy, ischaemia, and
infection lead to tissue breakdown resulting in
morbidity and possible amputation
( WHO 1995 )