The Charcot foot as a complication of diabetic neuropathy.

Diabetes mellitus is a leading global metabolic disorder accompanied by the overwhelming burden of its associated complications. Hyperglycaemia-induced endothelial damage or endothelial dysfunction serves as the primary instigator for the development of microvascular disease. Diabetic neuropathy represents the majority of microvascular sequelae and is the renowned perpetrator of a variety of foot complications, namely the Charcot foot (CF). CF is a debilitating medical emergency which is often mismanaged either due to a delayed diagnosis or lack of clinical expertise in the management of CF. Often, misdiagnosis during the acute stages of CF leads to irreversible and persistent joint destruction which may be refractory to medical or surgical treatment. Timely intervention with offloading measures is crucial during acute CF in ceasing active bone resorption. Current anti-resorptive agents may be considered as adjunctive therapy in combination with offloading. Novel agents are underway that will enable bone formation and suppress bone resorption.

Delayed diagnosis of Addison's disease: an approach to management.

Addison's disease accounts for the majority of cases of adrenal failure that are detected during hospital admissions. Unfortunately, prompt diagnosis of this condition is often delayed due to varied atypical manifestations and inadequate assessment at the time of presentation. We report a case of a 52-year-old woman who was detected to have hypotension during routine colonoscopy for evaluation of anaemia and progressive weight loss. During admission for evaluation of hypotension, she was also detected to have hyponatremia. Hyponatremia and hypotension failed to improve despite fluid resuscitation. Our endocrinological opinion was sought for and on further evaluation she was diagnosed with primary adrenal insufficiency. Glucocorticoid and mineralocorticoid replacement therapy were eventually instituted, which was followed by restoration of blood pressure and normalisation of serum sodium levels.

Peripheral arterial disease.

Peripheral arterial disease (PAD) is an atherosclerotic-driven condition that remains underdiagnosed and undertreated. In diabetic patients, PAD begins early, progresses rapidly, and is frequently asymptomatic, making it difficult to diagnose. Strict management of the metabolic instigators and use of screening techniques for PAD in diabetes can facilitate early diagnosis and reduce progression. Exercise is an equally effective treatment option in improving walking distance. Early revascularization must be offered early in suitable patients. Surgical bypass and endovascular revascularization are complementary and the choice of intervention should be applied appropriately by a multidisciplinary vascular team on a selective, patient-specific basis.

Pathogenesis and medical management of diabetic Charcot neuroarthropathy.

The Charcot foot is a problematic clinical entity that worsens in the absence of timely intervention. As of now, based on the ADA consensus report, offloading with TCC continues to remain the mainstay of therapy for CN.1 A standardized approach to the management of CN is depicted in Fig. 1. Furthermore, ongoing inflammatory activity can be controlled with antiresorptive agents, like BPPs and calcitonin; however, data acquired from larger trials with these agents are awaited. Newer agents that target the inflammatory cascade have been identified and applied in limited clinical trials in non-Charcot conditions. Their potential role in the future management of CN has yet to be established.