Abstract
A typical case of diabetic osteoarthropathy (Charcot's joint) is reported. The patient was a 53-year-old male, who was known to have had diabetes for 11 years. Destructive changes of the bones were initially found in the right navicular bone and the cuneiform bones, and subsequently invaded bones distal to the right foot joint. During 10 consecutive months, almost all bones distal to the ankle joint were destroyed without pain.
Electrophysiological studies revealed marked retardation of the maximal nerve conduction velocity. Sensory nerve conduction of the lower limb could not be evoked.
Pathological studies of nerves of the lower limb revealed a marked decrease in fiber density in both myelinated and unmyelinated fibers.
Based on teased nerve fiber studies, segmental demyelination and findings suggestive of axonal degeneration were found in all myelinated nerve fibers observed. Electronmicroscopic observations also revealed severe axonal degeneration and Schwann cell changes.
The pathogenesis of osteoarthropathy and the course and progress of the disease are discussed.
