Robert Frykberg, DPM, MPH
Robert Frykberg, DPM, MPH
The diabetic Charcot foot continues to be an enigma nearly one and a half centuries after the condition was thoroughly described in 1868 by Professor Jean-Martin Charcot of Paris. Although his patients were afflicted with tertiary lues, previously the most common disease associated with this disorder, most of his observations and insights still hold true today in our current understanding of this severely destructive joint disorder. Charcot’s arthropathy not only is a marker for the most complicated cases of diabetes mellitus but indeed is a limb-threatening disorder. Studies indicate that foot deformity, notably osteoarthropathy, is a primary risk factor for subsequent ulceration and lower-extremity amputation. Therefore, we must not only recognize this disorder early in its pathogenesis, but also fully appreciate the underlying pathophysiology leading to its development. Only through such an understanding can we rationally approach the management of this difficult condition.
This special issue of JAPMA highlights several of the presentations we enjoyed at a special Charcot symposium in June 2000 at the annual meeting of the American Diabetes Association, chaired by David G. Armstrong. It represents an overview of the state of our current understanding of this fascinating complication of long-term diabetes. Although our knowledge is still evolving, we draw from important lessons from the past as we move forward. When reviewing these contributions, we understand that in many ways, little is really new in our current management of Charcot’s arthropathy, save for a better awareness of its pathogenesis and a more timely, consistent therapeutic approach—but this in itself is a major step forward. Even surgical management of neuroarthropathy, fraught with potential complications and currently in vogue, was first reported almost 70 years ago. As you read through this issue, I trust that you will gain a broader appreciation of the potential magnitude of this disorder and develop greater insight into its peculiarities and proper management.
