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A specific and reliable test for Charcot Neuropathy is still missing

Review Article

Article Title:A specific and reliable test for Charcot Neuropathy is still missing

Author: Ulrich Illgner*, Armstrong DG, Slepian, Krenn V

Published Date: March 05, 2018

DOI: 10.26717/BJSTR.2018.02.000820

Abstract: Background: Charcot Neuropathy is a severe complication of patients with neuropathy mostly seen in the foot, but it can also appear in the knee or hand. Not only diabetic patients are involved. CN can lead to a complete collapse of the foot with subsequent ulceration and infection. The mechanism of this episode-like breakdown has not been understood so far. CN still remains mainly a clinical diagnosis depended on clinical experience because there is still no reliable and specific test even though imaging has improved. X-rays represent the traditional way to diagnose CN according to the classification of Eichenholtz of 1967. But at the time these alterations become visible, the bone is already damaged. Therefore Shiabata introduced the MRI as Stage 0 into this existing classification. New approaches using CT or PET/CT have been published. But these procedures are expensive, not everywhere available, do not show the situation of foot while weight-bearing and still often lead to wrong or unclear diagnoses. Usually it takes days to weeks until MRT or PET/CT can be performed. Especially to distinguish between infection and CN can remain difficult. There is no marker in blood sampling for diagnosis. New research indicates a possible role of changes in mRNA expression of collagens in the pathomechanism, which might be used in the future for histopathological tests. It would be important to create reliable and reproducible testing standards and signs unique for CN. Conclusion: It is important to diagnose patients with Charcot Neuroarthropathy in early stages to prevent destruction and ulceration by simple procedures such as supply with insoles and shoes. Understanding the pathological mechanism of CN and finding new criteria for new test are necessary.