シャルコー関節—足部を中心とした病態，診断，治療と予後

Charcot Neuroarthropathy: a Review of Pathophysiology, Diagnosis, Treatment, and Prognosis with a Focus on the Foot

シャルコー関節は「痛みを失った関節が破壊される」病態を示す。糖尿病性末梢神経障害に合併する足部，いわゆる「シャルコー足」が最も多く，潰瘍や感染を契機に切断へ至る重大な合併症である。発症早期の診断は困難だが極めて重要で，治療成否を左右する。治療は免荷が基本で，進行例では外科的治療も検討される。予後改善には変形を最小限に抑え，潰瘍を防ぎ歩行可能な足を維持することが目標であり，生涯にわたる管理が不可欠である。

Abstract

Charcot neuroarthropathy is characterized by progressive joint destruction resulting from the loss of pain sensation. The most common manifestation is Charcot foot associated with diabetic peripheral neuropathy, which is a serious complication that often leads to amputation due to ulcers or infection. Early diagnosis is challenging but crucial as it strongly influences treatment outcomes. Off-loading is the cornerstone of management, and surgical intervention should be considered in advanced cases. The primary goals of treatment are to minimize deformity, prevent ulceration, and preserve the functional ambulatory foot. Lifelong management is essential to achieve favorable outcomes.