Pathophysiology of Diabetes and Charcot Neuroarthropathy

Diabetes and Charcot neuroarthropathy are complex diseases that have substantial healthcare implications and cost. The pathophysiology of these diseases, as it applies to the orthopedic surgeon, is not completely understood but is continuing to evolve. This chapter serves to illustrate the current knowledge regarding the pathogenesis of the musculoskeletal complications of diabetes. The focus is on the effect of diabetes and hyperglycemia on the nervous, vascular, and immune system. The historical perspectives on the pathogenesis of Charcot arthropathy (the neurotraumatic and neurovascular theories) are also discussed along with a description of the modern evolution of these theories. Inflammation has become the focus of much of the research in both diabetes and Charcot arthropathy and has been linked to both diseases through several cellular pathways. As we continue to clarify the pathogenesis of these diseases, the potential for therapeutic targets will emerge.