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

Charcot foot
J. Terrence Jose Jerome, CC BY 3.0, via Wikimedia Commons

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


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
0 – ClinicalLimited weight bearing (possibly TCC or PPWB), close observation
1 – FragmentationTCC, limited weight bearing
2 – CoalescenceTCC followed by CROW
3 – ReparativePossible surgical intervention for removal of bony prominences associated with ulceration
TCC = Total Contact Cast; PPWB = Prefabricated Pneumatic Walking Brace; CROW = Charcot Restraint Orthotic Walker

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