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Klinische Neurophysiologie 2020; 51(02): 67-72
DOI: 10.1055/a-1134-2547
Originalia

Die Rolle der diabetischen Neuropathie bei der Genese des Charcot-Fußes

Diabetic Neuropathy and the Charcot foot
Maike F. Dohrn
1   Neurologische Klinik, Universitätsklinik der RWTH Aachen, Aachen
,
Sigurd Kessler
2   OTHOEVO, München
,
Manuel Dafotakis
1   Neurologische Klinik, Universitätsklinik der RWTH Aachen, Aachen
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Zusammenfassung

Die neuropathische Osteo(arthro-)pathie, auch Charcot-Fuß genannt, ist eine progressive, nicht-infektiöse Schwellung mit Überwärmung und Demineralisierung, gefolgt von Knochendestruktion und Deformierung, die in ca. 75% unilateral auftritt und in einer Defektheilung zum Stillstand kommt. Resultierende Fehlstellungen können zu neuropathischen Ulzera führen, die sich infizieren und Amputationen erforderlich machen können. Die häufigste, aber nicht einzige Ursache ist der Diabetes mellitus. Etwa 2% aller Diabetiker entwickeln einen Charcot-Fuß. Der pathophysiologische „Charcot-Prozess“ ist komplex, scheint aber untrennbar mit der vorausgehenden Neuropathie verbunden zu sein. Die C- und Aδ- Fasern sind im Rahmen der diabetischen Neuropathie früh und häufig geschädigt, was ein Ungleichgewicht an CGRP, VIP, Substanz P und weiteren Transmittern erklärt. Störungen der Knocheninnervation verschieben das Verhältnis von Knochenan- und -abbau, von OPG und RANKL zugunsten des Abbaus. Demnach stellt die Fehlregulation nozizeptiver Nervenfasern auf molekularer Ebene eine pathophysiologische Brücke zwischen Diabetes mellitus und neurogener Inflammation dar.

Abstract

The neuropathic osteo(arthro-)pathy, also called Charcot foot, constitutes a progressive, non-infectious, self-limiting, foot inflammation and demineralization followed by bone destruction and deformity, which occurs unilaterally in 75% of cases resulting in permanent defect of the foot involved. As a consequence of malposition, ulcers, potentially complicated by infections, can make amputations necessary. With about 2% of all diabetics affected, diabetes mellitus is the most frequent, but not exclusive cause of Charcot foot to date. The pathophysiological process leading to this condition is complex; it is, however, closely linked to a preceding neuropathy. The small C- und Aδ nerve fibers are particularly prone to damage in the early course of diabetic neuropathy leading to an imbalance of neurotransmitters such as CGRP, VIP, substance P, and others. Disturbances in bone innervation shift the equilibrium between bone formation and degradation represented by OPG and RANKL, respectively, in favor of demineralization. It is suspected that dysregulation of nociceptive nerve fibers builds the pathophysiological bridge between diabetes mellitus and neurogenic inflammation causing the formation of Charcot foot.

Schlüsselwörter

Charcot-Fuß - Diabetische Neuropathie - Neurogene Inflammation - Knocheninnervation - Diabetes mellitus

Key words

Charcot foot - diabetic neuropathy - neurogenic inflammation - bone innervation - diabetes mellitus


Publikationsverlauf

Artikel online veröffentlicht:
28. April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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