Trophic Changes

Trophic Changes

1.Trophic Changes In The Skin & Appendages:

Dry/ Rough/ Cold Skin

Pigmentation

Local Cyanosis/Local Oedema

Hypohydrosis (Lack Of Sweating)

Hypotrichosis(Fall Of Hairs)

Brittle Nails

2.Trophic Ulcers:

Trophic Ulcer- Usually Present Over The Heel Or Ball Of The Great Toe

Sites Examined-

On The Lateral Malleolus

Back Of The Heel Of Foot

Shoulder Girdles

Over The Sacrum (Classical Bed Sore)

3.Charcot Joint / Neuropathic Joint:

This Is A Chronic, Progressive Degenerative Arthropathy.

Characterised By–

Huge Swelling Of Knee (Most Common Site), Hip, Ankle Or Shoulder Joints.

Painless( Most Characteristic)

Disorganised, Deformed And Destroyed Joint.

Increased Mobility Of Joint And Thus Easy Dislocation Is Possible

Loose Bodies May Be Palpated In The Joint Cavity And Crepitus May Be Felt

Causes Of Trophic Ulcer In Feet/ Charcot Joint-

Leprosy

Diabetes Mellitus

Syringomyelia

Tabes Dorsalis

Sometimes After Repeated Intra-Articular Injection Of Steroid

Charcot Joint Is The Complication Of Chronic Loss Of Proprioception.

Pathophysiology Of Development Of Charcot Joint-

Loss Of Proprioception → Recurrent Trauma → Damage Got Unnoticed By The Neuropathic Patient → Progressive Destruction, Degeneration And Disorganisation Of The Joint.

Radiological Features Of Charcot Joint-

Osteopenia

Sharp Cortical Margin

Severe Disruption & Disorganisation Of The Joint

Inappropriate New Bone Formation

Management Of Charcot Joint-

Treatment Of Underlying Disorder

Stabilisation Of The Joint Is Done By Braces & Splints.

In Case Of Diabetes Mellitus, Prevent Weight Bearing In The Foot For 2 Months To Prevent Severe Diseases (Trophic Ulcer).

Lastly Fusion Of A Very Unstable Joint May Be Done

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