8 modules on Charcot neuroarthropathy, the destructive joint disease of diabetic feet. From Jean-Martin Charcot 1868 to RANK/RANKL/OPG molecular biology, Eichenholtz staging, total contact casting, surgical reconstruction (super-construct, Ilizarov), and the IWGDF prevention framework.
Eight Modules
- Part I — Overview & Epidemiology: Charcot 1868 in tabes dorsalis, modern aetiology dominated by diabetes (~85%), incidence in DM (0.1–7%), the pathognomonic warm-swollen-erythematous neuropathic foot.
- Part II — Pathophysiology: Neurotrophic vs neurovascular theories reconciled; RANK/RANKL/OPG molecular engine with osteoclast activation; Jeffcoate-Game inflammatory model; AGE accumulation; the unified 9-step model.
- Part III — The Diabetic Foot: Loss of protective sensation, Semmes-Weinstein 5.07 monofilament, peak plantar pressures, peripheral arterial disease, IWGDF risk stratification.
- Part IV — Imaging: Plain radiographs (5 Ds), MRI as gold standard, the Charcot-vs-osteomyelitis discriminator, CT, nuclear / FDG-PET.
- Part V — Eichenholtz Staging: Stages 0–III, Brodsky anatomic classification, Sanders, Frykberg, sample chart entries.
- Part VI — Conservative Management: Total contact casting (the standard of care), CROW, instant TCC, monitoring with skin-temperature differential, bisphosphonates and denosumab evidence.
- Part VII — Surgical Management: Indications, exostectomy, midfoot beam arthrodesis, retrograde TTC nail, internal vs external (Ilizarov) fixation, Sammarco super-construct principles.
- Part VIII — Prevention & Prognosis: DCCT/UKPDS, annual foot exam, IWGDF-stratified footwear, multidisciplinary "toe-and-flow" clinics, 5-yr post-amputation mortality (50–70%, comparable to many cancers).
The course is built around the 2023 IWGDF guideline framework and integrates RANK/RANKL/OPG molecular biology, Eichenholtz radiographic staging, and the modern total-contact-casting standard of care.