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. In some instances, amputation becomes unavoidable.
et al. Results of simple conservative treatment of midfoot Charcot arthropathy. Clin Orthop Surg. 2019 Dec;11(4):459–65.