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Jean-Martin Charcot (1825–1893)
The Man Behind the Joint Disease
Jean-Martin Charcot was one of the most celebrated French physicians of the 19th century. A masterful teacher and a captivating lecturer, Charcot created the foundations of neurology as an independent discipline, and transformed the Salpêtrière hospital, in Paris, into one of the world’s greatest teaching centers for clinical neurologic research. His name is attached to the distinct pathologic entity, Charcot’s joint disease, that he so meticulously described. This article reviews the highlights of Charcot’s career and his clinicoanatomic studies of patients with tabetic arthropathies. (J Am Podiatr Med Assoc 92(7): 375-380, 2002)
Introduction
The Challenge of Peripheral Arterial Disease in People with Diabetes: A Call to Action
History of the Team Approach to Amputation Prevention
Pioneers and Milestones
This historical perspective highlights some of the pioneers, milestones, teams, and system changes that have had a major impact on management of the diabetic foot during the past 100 years. In 1934, American diabetologist Elliott P. Joslin noted that mortality from diabetic coma had fallen from 60% to 5% after the introduction of insulin, yet deaths from diabetic gangrene of the lower extremity had risen significantly. He believed that diabetic gangrene was preventable. His remedy was a team approach that included foot care, diet, exercise, prompt treatment of foot infections, and specialized surgical care.
The history of the team approach to management of the diabetic foot chronicles the rise of a new health profession—podiatric medicine and surgery—and emergence of the specialty of vascular surgery. The partnership among the diabetologist, vascular surgeon, and podiatric surgeon is a natural one. The complementary skills and knowledge of each can improve limb salvage and functional outcomes. Comprehensive multidisciplinary foot-care programs have been shown to increase quality of care and reduce amputation rates by 36% to 86%. Development of distal revascularization techniques to restore pulsatile blood flow to the foot has also been a major advancement.
Patients with diabetic foot complications are among the most complex and vulnerable of all patient populations. Specialized diabetic foot clinics of the 21st century should be multidisciplinary and equipped to coordinate diagnosis, off-loading, and preventive care; to perform revascularization procedures; to aggressively treat infections; and to manage medical comorbidities. (J Am Podiatr Med Assoc 100(5): 317–334, 2010)
Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed. (J Am Podiatr Med Assoc 96(6): 474–481, 2006)
The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity. (J Am Podiatr Med Assoc 101(5): 437–446, 2011)
