Neurogenic arthropathy is joint destruction resulting from loss or diminution of proprioception, pain, and temperature perception. Although initially described in the knees of patients with tabes dorsalis, it is more frequently seen in association with diabetic neuropathy (foot and ankle) or syringomyelia (shoulder). As normal muscle tone and protective reflexes are lost, secondary degenerative joint disease ensues, resulting in an enlarged, boggy, relatively painless joint with extensive cartilage erosion, osteophyte formation, and multiple loose joint bodies. Radiographs can reveal striking osteolysis that mimics osteomyelitis or dramatic destruction of the joint with subluxation, fragmentation of bone, and bony sclerosis.
Treatment is directed toward the primary disease; mechanical devices are used to assist in weight bearing and prevention of further trauma. Surgical strategies, including arthrodesis, with or without orthobiologics, can be considered if nonsurgical management fails. Pharmacotherapy has not demonstrated efficacy for this condition.
et al. Efficacy of medical treatment for Charcot neuroarthropathy: a systematic review and meta-analysis of randomized controlled trials. Acta Diabetol. 2021;58:687.