Charcot Cysts: A Rarely Reported Finding

Jaminelli Banks, Annie Jong and Robert Frykberg

Department of Podiatry, University of Arizona College of Medicine-Phoenix, Phoenix VA Health Care System, USA

^*Correspondance to: Robert Frykberg 

 PDF  Full Text DOI: 10.25107/2474-1647.1630

Abstract

Aims/Goals: Charcot arthropathy is a debilitating condition affecting the lower extremity of persons with long established peripheral neuropathy. Deformities of the midfoot can place the foot at risk of ulceration and subsequent amputation if infection ensues. Although surgical management has become much more common for this disorder, there has been little, if any, mention of a peculiar cystic proliferation noted in the deep soft tissues upon surgical dissection. We herein report our observations on several patients who were found to have what we have termed “Charcot Cysts.”Methods: Three type 2 diabetic patients are presented who reported to our High Risk Foot Clinic with Charcot arthropathy of the midfoot represented by a collapse of the midfoot and loss of calcaneal inclination. These patients were treated per our customary treatment of wound care, offloading boots, and instructions for non weight bearing as indicated. Although all patients were given instructions and supplies for wound care and provided with therapeutic footwear appropriate for their condition, two patients persisted with midfoot ulceration. The other went on to develop a plantar soft tissue mass. Despite further casting, the ulcers and mass remained recalcitrant to conservative care. All patients were taken to surgery for a simple plantar exostectomy to reduce the plantar bony prominence underlying the chronic ulceration or mass.Results: Upon deep exploration a translucent, fluctuant, multi-loculated cystic mass was encountered that extended throughout a considerable portion of the dissection. Upon resection, the masses were found to be spongy and contained what appeared to be synovial fluid. Pathology confirmed that these were simple benign cysts. Importantly, however, we found a delay in wound healing caused by persistent synovial fluid leakage.Conclusions: This rarely reported complication of the diabetic Charcot foot has been noted by the senior author (RGF) in many such operative patients over the last several decades. Since most patients with Charcot foot are treated conservatively, these cysts are not usually recognized surgically. Once the foot becomes ulcerated or is treated surgically, however, the Charcot cysts can be shown to have impeded normal wound healing. While the pathogenesis of Charcot neuroarthropathy has been previously described, the formation of such related cysts has yet to be explained. We, therefore, encourage clinicians and surgeons to corroborate our findings with further study of this interesting pathology.

Keywords

Charcot; Charcot foot; Charcot arthropathy; Charcot neuroarthropathy; Cyst; Synovial cyst

Cite the article

Banks J, Jong A, Frykberg R. Charcot Cysts: A Rarely Reported Finding. Clin Surg. 2017; 2: 1630.