Coupon Accepted Successfully!


Neuropathic Joint Disease/ Charcot’s Joint

It is progressive destructive arthritis arising from loss of pain sensation and propirioception (position sense). In addition normal muscular reflexes that modulate joint movements are decreased. So these joints lack normal reflex safe guards against abnormal stress or injury and subchondral bone disintegrates with alarming speed.

  1. Causes
    1. Diabetes mellitus (most common)
    2. Leprosy
    3. Tabesdorsalis (neurosyphilis) = 2nd m.c
    4. Yaws
    5. Syringomyelia
    6. Meningomyelocoele
    7. Spinal cord compression
    8. Congenital indifference to pain
    9. Peroneal muscular atrophy (Charcot Marie Tooth disease)
    10. Amylodiosis

Pattern of Joint Involvement



Joint Involvement


Midtarsal (most common) >tarsometatarsal metatarsophalangeal and ankle joint> knee & spine

Tabes dorsalis

Knee (most common), hip, ankle and lumbar spine


Interphalangeal (hands), metatarsophalangeal (feet), and lower limbs.


Shoulder (glenohumeral), elbow, wrist and cervical spine

  1. Clinical Presentation
    1. Begins in as single joint & progress to involve other joints. Joint becomes progressively enlarged from bony overgrowth and synovial effusion.
    2. Loose bodies may be palpated in the joint. Joint instability, subluxation, & crepitus occurs as the disease progresses.
    3. Patients complains of weakness, swelling, instability, laxity & progressive deformity usually involving knee or ankle. The markedly swollen joint is neither tender nor warmth.
    4. The appearance suggest that movements would be agonizing and yet it is often painless. The paradox is diagnostic i.e. the amount of pain experienced is less than would be anticipated based on degree of joint involvement

Description: images-1

  1. Radiological Features
    1. Similar to OA i.e. joint space narrowing, subchondral bone sclerosis, osteophytes and joint effusion, followed by marked destructive and hypertrophic changes. However the process is usualy more rapid. Joint swelling and appearance of intra-articular calcification are further clues.
    2. It may be difficult to differentiate it from osteomyelitis, especially in diabetic foot. The joint margins in neuropathic joints tend to be distinct, while in osteomyelitis, they are blurred. MRI and bone scan using indium labeled WBC/immunoglobin G (increased uptake in osteomyelitis but not in neuropathic joint) can differentiate. Tc scan will not distinguish as increased uptake is observed in both.
    3. Treatment of Charcot’s arthropathy is limitation of joint movements by bracing or casting, joint debridement (arthrocentesis) and fusion of joint (arthrodesis)

Test Your Skills Now!
Take a Quiz now
Reviewer Name