Introduction:
Charcot Knee is the chronic, progressive, non-infectious destruction of bone and joints, in patients with peripheral neuropathy, as first described by William Musgrave in 1703 . Charcot neuroarthropathy of the knee (CK) is a rare and under-researched area, resulting in considerable morbidity. However, it is a common foot and ankle related pathology, especially in those with diabetes mellitus.
Definition:
Charcot knee is a chronic, progressive degenerative arthropathy characterizes by joint deformity, destruction and instability, resulting from impaired pain sensation and proprioception , most commonly due to peripheral neuropathy.
Etiology:
The primary etiology of charcot knee is any condition causing peripheral neuropathy, which compromises the joint’s protective reflexes and awareness of injury. Common causes include:
- Diabetes Mellitus: The most frequent cause, accounting for a significant majority of cases.
- Spinal cord injury: Leading to loss of sensation below the level of injury.
- Tabes Dorsalis(Syphilis): Historically a common cause.
- Leprosy: Another infectious cause of neuropathy.
- Alcoholism: Can cause peripheral neuropathy.
- Syringomyelia: A neurological disorder characterized by a fluid- filled cyst within the spinal cord.
Signs & Symptoms:
- Skin Changes: Scar or ulcerations may develop due to altered biomechanics and pressure points.
- Clicking: During movement.
- Joint Instability: Leading to difficulty gait pattern.
- Diminished or Absence pain: Despite severe damage.
- Warm, swollen joint: Often the initial noticeable sign.
- Progressive deformity: Visibly altering the knee’s alignment.
Physiotherapy Management:
Physiotherapy plays a crucial role in managing charcot knee, focusing on:
- Therapeutic Exercises (Non- weight Bearing): Maintaining range of motion and strengthening surrounding muscles without stressing the joint.
- Diabetic Foot Care:
- Inspect your feet daily, Check for cuts, blisters, redness, swelling or nail problems and inform doctor if you notice any changes.
- Bathe feet in lukewarm water.
- Wash feet using a soft washcloth or sponge. Dry by blotting or patting and carefully dry between the toes.
- Moisturize your feet but not between toes as it can cause fungal infections.
- Never treat corns or calluses yourself.
- Wear clean, dry socks and change them daily.
- Wear socks to bed.
- Shake out your shoes and feel the inside before wearing to check for any foreign bodies.
- Keep your feet warm and dry. Consider using an antiperspirant on soles.
- Never walk barefoot.
- Keep blood sugar levels under control.
- Cut nails carefully.
- Get periodic foot exams.
- Diabetes Complication and Amputation Prevention.
- Shoes and Orthotics for Diabetics
- Weight-Bearing Modification: Use of crutches( axillary, elbow) ,wheelchairs or walkers to offload the affected joint.
- Orthotics and Bracing: Custom-made knee braces(e.g., total contact orthosis) to stabilize the joint and prevent further deformity.
- Pain Management modalities: Low level LESER irradiation for 10-15 minutes/session on the ulcer.
- Balance and Proprioception: If appropriate and safe , to improve overall stability.
Complications:
- Weak bones
- Deformity: Rocker Bottom.
- Bones may press against shoes.
- Ankle may become twisted and unsteady.
- Toe curls.
Conclusion:
Charcot Knee is a challenging condition requiring early diagnosis and comprehensive management. While joint destruction can be severe, a multidisciplinary approach, with physiotherapy as a cornerstone, can significantly improve functional outcomes, prevent further progression and enhance the patient,s quality of life.