Bilateral Charcot Neuroarthropathy in Pregnancy: A Case Report And Review of the Influence of Pregnancy Hormones on Ligament Laxity

Overview

Journal AACE Clin Case Rep

Specialty Endocrinology

Date 2021 Apr 14

PMID 33851021

Authors

Rebecca Rogers

Ketan K Dhatariya

Affiliations

Soon will be listed here.

Abstract

Objective: To describe the case of a woman with long-standing poorly controlled type 1 diabetes mellitus who developed bilateral Charcot foot while pregnant. To the best of our knowledge, this is the first reported case of this condition in pregnancy.

Methods: We performed a retrospective review of physical paper medical records; electronically held laboratory results, including glycated hemoglobin; and imaging reports, including plain radiographs and magnetic resonance imaging.

Results: The Charcot feet were treated by standard offloading in total-contact casts or below-knee removable walking boots. As 1 side resolved, the patient was stepped down into normal footwear on one side and a below-knee walking boot on the other. A review of the literature suggests that the increase in ligamentous laxity associated with a rise in circulating hormones, such as relaxin, increases the risk of developing Charcot neuroarthropathy.

Conclusion: Bilateral concurrent Charcot neuroarthropathic foot is uncommon, and to our knowledge, this is the first reported case in pregnancy. We present a possible explanation for why there is an increased risk for the development of Charcot neuroarthropathy in pregnancy.

References

MacLennan A . The role of the hormone relaxin in human reproduction and pelvic girdle relaxation. Scand J Rheumatol Suppl. 1991; 88:7-15. View

Milne T, Rogers J, Kinnear E, Martin H, Lazzarini P, Quinton T . Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy: a systematic review. J Foot Ankle Res. 2013; 6(1):30. PMC: 3737070. DOI: 10.1186/1757-1146-6-30. View

Loupa C, Meimeti E, Kokas A, Voyatzoglou E, Donou A . An atypical and bilateral presentation of Charcot foot disease. BMC Endocr Disord. 2019; 19(1):96. PMC: 6727523. DOI: 10.1186/s12902-019-0422-z. View

Kaynak G, Birsel O, Guven M, Ogut T . An overview of the Charcot foot pathophysiology. Diabet Foot Ankle. 2013; 4. PMC: 3733015. DOI: 10.3402/dfa.v4i0.21117. View

Mascarenhas J, Jude E . The Charcot foot as a complication of diabetic neuropathy. Curr Diab Rep. 2014; 14(12):561. DOI: 10.1007/s11892-014-0561-6. View

Lymbouris M, Gooday C, Dhatariya K . Mitochondrial dysfunction is the cause of one of the earliest changes seen on magnetic resonance imaging in Charcot neuroarthopathy - Oedema of the small muscles in the foot. Med Hypotheses. 2019; 134:109439. DOI: 10.1016/j.mehy.2019.109439. View

Somerson J, Isby I, Hagen M, Kweon C, Gee A . The Menstrual Cycle May Affect Anterior Knee Laxity and the Rate of Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-Analysis. JBJS Rev. 2019; 7(9):e2. DOI: 10.2106/JBJS.RVW.18.00198. View

Rosenbaum A, Dipreta J . Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res. 2014; 473(3):1168-71. PMC: 4317422. DOI: 10.1007/s11999-014-4059-y. View

Jeffcoate W . Charcot foot syndrome. Diabet Med. 2015; 32(6):760-70. DOI: 10.1111/dme.12754. View

10.

Leblanc D, Schneider M, Angele P, Vollmer G, Docheva D . The effect of estrogen on tendon and ligament metabolism and function. J Steroid Biochem Mol Biol. 2017; 172:106-116. DOI: 10.1016/j.jsbmb.2017.06.008. View

11.

Chaudhuri A, Umpierrez G . Oxidative stress and inflammation in hyperglycemic crises and resolution with insulin: implications for the acute and chronic complications of hyperglycemia. J Diabetes Complications. 2012; 26(4):257-8. PMC: 3718464. DOI: 10.1016/j.jdiacomp.2012.04.016. View

12.

Fauzi A, Chung T, Latif L . Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre. Singapore Med J. 2016; 57(4):198-203. PMC: 4853487. DOI: 10.11622/smedj.2016074. View

13.

Heitz N, Eisenman P, Beck C, Walker J . Hormonal changes throughout the menstrual cycle and increased anterior cruciate ligament laxity in females. J Athl Train. 2006; 34(2):144-9. PMC: 1322903. View

14.

Wojtys E, Huston L, Boynton M, Spindler K, Lindenfeld T . The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sports Med. 2002; 30(2):182-8. DOI: 10.1177/03635465020300020601. View

15.

Steinetz B, Whitaker P, Edwards J . Maternal relaxin concentrations in diabetic pregnancy. Lancet. 1992; 340(8822):752-5. DOI: 10.1016/0140-6736(92)92295-q. View

16.

Game F, Catlow R, Jones G, Edmonds M, Jude E, Rayman G . Audit of acute Charcot's disease in the UK: the CDUK study. Diabetologia. 2011; 55(1):32-5. DOI: 10.1007/s00125-011-2354-7. View