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Diabetic neuroarthropathy of the foot and ankle.

A review of medical literature reveals that there is inconsistency in the reported incidence of Charcot joint disease or neuroarthropathy in the diabetic foot. There is also controversy as to which articulations are most commonly afflicted. Radiographs of 21 patients with bilateral diabetic neuroarthropathy were reviewed to determine the distribution of joint disease in the foot and ankle. Many patients had multiple sites of joint involvement. The results of this study show that the incidence of metatarsophalangeal joint involvement has been greatly underestimated.

Ankle Joint↗

Charcot's foot.

Charcot's foot used to be considered an unusual complication of diabetic peripheral neuropathy. With the current appreciation that approximately 25% of adult diabetics have an appreciable peripheral neuropathy, it is understandable that Charcot's neuro-osteoarthropathy has become recognized as a major problem for clinicians caring for diabetics. Differentiation from acute diabetic foot infection is the first challenge. Once Charcot's foot is identified, treatment generally involves immobilization during the acute inflammatory stage. When deformity develops, the orthopedic foot and ankle surgeon must decide whether accommodative care with a combination of inlay depth shoes, accommodative foot orthoses, and ankle-foot orthoses is adequate. If a plantigrade weight-bearing surface cannot be achieved, surgical stabilization or reconstruction requires rigid stabilization in a poor biomechanical environment using tools that are not designed for structures as small as the foot. The controversies presented to clinicians charged with care of this difficult patient population are as follows: 1. When to allow weight bearing in the acute phase of the disease process. 2. Whether prefabricated devices are as successful as the total contact cast in the acute phase. 3. Early surgical stabilization versus accommodation when deformity first develops. 4. Late reconstruction versus accommodation or amputation in the deformed late stages.

Ankle Joint↗

[Method of compression arthrodesis of the ankle and foot joints].

A modified F.R. Bogdanov arthrodesis of the talocrural joint is described. The authors employed an external compression with three Kirschner pins, inserted in the tibial, calcanial and scaphoid bones. Late results of the operation were followed up in 20 patients. A complete correction, osteoankylosis of arthrodesized joints and rehabilitation of the weight-bearing function of the foot and extremity, as a whole, were gained in all patients.

Adolescent↗

[Pathological and histopathological findings in the joints of fattening turkeys].

This paper reports on pathological and histopathological findings in the joints of male turkeys (B.U.T. Big 6) reared in two different housing systems. Pathological investigations were conducted on all animals which died between the 6th week of life and the end of fattening (585 birds, 1170 hip, knee and intertarsal joints) from four fattening periods with 3000 birds each. This study included 297 birds kept in a conventional housing system (barn 2) with a stocking density of 2.8 birds/m2, and 288 birds from a barn (1) from which the animals had access to an outdoor scratching area (stocking density 2.5 birds/m2). In all, 157 (26.5%) of the 585 fallen turkeys (barn 1:93; barn 2:70) showed at least one pathological joint alteration. and there were macroscopically detectable changes in 274 (7.8%) of the 3510 investigated joints: 152 (7.8%) of the 1728 joints from barn 1, and 122 (8.8%) of the 1782 from barn 2. In both housing systems the most frequent pathological alterations were in the intertarsal joint affecting 16% (188) of these 1170 joints (barn 1:106; barn 2:82); next most frequent were changes in the knee joint with 4.5% (53) of the 1170 joints affected (barn 1:26; barn 2:27). In both barns, synovial alterations occurred predominantly in the intertarsal and the knee joints. Bacteriological investigation of altered synovial fluids (83) most frequently showed an infection with Staphylococcus spp. (44) and E. coli (15). Macroscopic investigation showed alterations in 31 (2.7%) of the 1170 hip joints (barn 1:19; barn 2:12); 2% (22) of these showed cartilage degenerations of the femoral head (barn 1:15; barn 2:7). Histological investigation of these cartilage lesions showed that they were predominantly (70%) due to osteochondrosis with complete epiphyseolysis affecting 16 femoral heads (barn 1:10; barn 2:6). Partial epiphysiolysis was found in 24% (5) of the femoral heads (barn 1:4; barn 2:1). Furthermore, 43% (9) of the 22 femoral heads with cartilage degeneration also had osteomyelitis and osteochondritis, as well (barn 1:6; barn 2:3). Histological investigation of the 104 femoral heads with no macroscopic findings (barn 1:56; barn 2:48), revealed osteochondrosis in 11 cases (10.6%) (barn 1:6; barn 2:5). Osteomyelitis and osteochondritis were found in 17 (16.3%) of these femoral heads (barn 1:9; barn 2:8). There were no significant (p < 0.05) differences between the two housing systems in the incidence and frequency of joint alterations. It is to be assumed that these joint alterations were the cause of acute, chronic pain.

Animals↗

Diabetic arthropathy of the first metatarsal cuneiform joint. Introduction of a new surgical fusion technique.

This paper describes the surgical treatment of advanced arthropathy of the first metatarsal cuneiform joint in the diabetic patient. A new surgical procedure is described as performed on a 59-year-old black diabetic woman with advanced arthropathy of the first metatarsal cuneiform joint. A brief review of diabetic arthropathy is presented, with special emphasis on the first metatarsal cuneiform joint involvement. The authors believe that with early diagnosis and surgical fusion, the process of rapid tarsal disintegration can be prevented.

Arthropathy, Neurogenic↗

Polyarticular pigmented villonodular synovitis in children: evidence for a genetic contribution.

Pigmented villonodular synovitis rarely occurs in multiple joints, and only once has been noted in siblings. We identified this disorder in 2 generations and found evidence for its presence in a third. It occurred in 2 sibling children at multiple sites. All affected individuals also had a rare autosomal dominant disorder, the multiple lentigines syndrome. Among the developmental abnormalities in this kindred were fibrous dysplasia, hypertelorism, pectus excavatum, high arched palate, and primary lymphedema. The etiology of pigmented villonodular synovitis is uncertain, and suggested causes include trauma, inflammation, neoplasia, and repeated hemorrhage. Our observations suggest genetic factors might also be important in the development of pigmented villonodular synovitis.

Adolescent↗