Charcot Arthropathy : Mnemonics

Causes of Charcot Arthropathy

Mnemonic: 10 S

1. Sugar (diabetes) – most commonly foot and ankle
2. Syringomyelia – 80% in shoulder and elbow
3. Spinal cord injury – hip, knee, ankle and spine
4. Spastic paraplegia
5. Syphilis – most commonly knee
6. Spirits (alcohol)
7. Subacute combined degeneration
8. Steroids
9. Scaly disease (leprosy) – 2nd most common cause in upper extremity
10. Scleroderma

3 Theories of Charcot Arthropathy

a. Neuro-traumatic: Damage to sensory feedback → Repeated microtrauma → Release of proinflammatory cytokines → Bone resorption

b. Neuro-vascular: Change in vascularity caused by dysregulation of vasomotor and trophic nerve supply

c. Neuro-inflammatory: Abnormal persistence of inflammatory response and inability to terminate inflammatory response

Classic features

Mnemonic: 6 Ds

1. Destruction
2. Disorganization
3. Debris (loose bodies)
4. Density (sclerosis)
5. Distension (joint effusion)
6. Dislocation (dislocation/subluxation)

Eichenholz classification

Mnemonic: CDCR or IFCC

1. Clinical (Inflammatory) – Demineralization
2. Dissolution (Fragmentation) – Debris and Dislocation
3. Coalescence – Debris absorption and Density increase
4. Resolution (Consolidation) – Deformity

Treatment

Mnemonic: ABCDEF

1. Activity limitation
2. Bracing or Casting (Total contact cast)
3. Discontinue when skin temperature normal
4. Evade total joint arthroplasty
5. Fusion after inflammatory phase in feet

Stage	Treatment
0 – Clinical	Limited weight bearing (possibly TCC or PPWB), close observation
1 – Fragmentation	TCC, limited weight bearing
2 – Coalescence	TCC followed by CROW
3 – Reparative	Possible surgical intervention for removal of bony prominences associated with ulceration