Alcohol-induced Neuroarthropathy in the Foot: A Case Series and Review of Literature Naohiro Shibuya, DPM, AACFAS, 1 Javier La Fontaine, DPM, MSc, FACFAS, 2 and Stephen J. Frania, DPM, FACFAS 3 Charcot arthropathy, also known as neuroarthropathy, is most commonly associated with diabetes mellitus, despite a variety of other etiologies. A limited number of case reports have been published on neuroarthropathies caused by other forms of neuropathy, including alcoholic peripheral neuropathy. We report 4 cases of neuroarthropathy associated with chronic alcoholism in nondiabetic individuals. Conservative management similar to that afforded diabetic patients was successfully employed in these cases. A review of the clinical presentation and the pathology of alcoholic neuropathy is included in this report. ACFAS Level of Clinical Evidence: 4 ( The Journal of Foot & Ankle Surgery 47(2):118 –124, 2008) Key Words: alcoholic peripheral neuropathy, Charcot foot, Charcot neuroarthropathy, diabetic neurop- athy, foot ulcer, peripheral neuropathy, rockerbottom foot N euroarthropathy is a painful and debilitating condition commonly seen in a foot and ankle practice. Although the pathophysiology of neuroarthropathy is subject to debate, neuropathy has been shown to be a risk factor for develop- ment of the condition (1). While typically presenting as a complication of diabetes mellitus, neuroarthropathy can oc- cur as a consequence of other conditions, including chronic vascular insufficiency and chronic alcohol abuse. In severe cases, neuroarthropathy can progress to Charcot neuroar- thropathy, a destructive condition involving joint instability, and a rockerbottom foot deformity with development of bony prominences. These abnormalities often lead to ulcer- ation (2) and, ultimately, lower extremity amputation. While Charcot neuroarthropathy associated with diabetes mellitus has been widely described, there are a limited number of case reports describing neuroarthropathy caused by other forms of neuropathy. In this report, 4 cases involv- ing nondiabetic patients with neuroarthropathy due to chronic alcohol abuse are presented. Case 1 A 49-year-old male with a past medical history of hyper- tension, bipolar disorder, chronic obstructive pulmonary disease (COPD), chronic kidney disease, chronic alcohol- ism, and a history of noncompliance with medical regimens, presented to our clinic (the Texas Diabetes Institute podiatry clinic) with a chief complaint of painful toenails. He denied pain or other problems in the lower extremities. The patient had no history of diabetes, which was confirmed with a series of blood tests during follow-up visits. His medica- tions included divaloproex, clonazepam, simvastatin, nisol- dipine, seroquel, metoprolol, clonazepam, olanzapine, bu- propion, risperidone, hydrochlorothiazide, enalapril, and furosemide. He denied any drug allergies. The past surgical history was significant for a knee operation at 18 years of age. He smoked 2 packs of cigarettes daily for “several” years, and was a chronic alcohol abuser until 20 years prior to presentation to our clinic. He did not specify the type of alcoholic beverages he consumed, nor did he remember when he started drinking heavily. His family history in- cluded myocardial infarction and congestive heart failure. His body mass index (BMI) was calculated to be 36 kg/m 2 . Vascular examination revealed palpable pedal pulses Address correspondence to: Naohiro Shibuya, DPM, 7703 Floyd Curl Dr. Mail Code# 7776, San Antonio, TX 78229 –3900. E-mail: shibuya@uthscsa.edu. 1 Clinical Instructor, Department of Orthopaedics/Podiatry, The Univer- sity of Texas Health and Science Center at San Antonio; Second-year student, Master’s of Science in Clinical Investigation, The University of Texas Health and Science Center at San Antonio; Associate, American College of Foot and Ankle Surgeons, San Antonio, TX. 2 Assistant Professor, Interim Chair, Division of Podiatry, Department of Orthopaedics, The University of Texas Health and Science Center at San Antonio; Director, Podiatric Residency Training Program, Texas Diabetes Institute, Podiatry Clinic; Fellow, American College of Foot and Ankle Surgeons; Diplomate, American Board of Podiatric Surgery, San Antonio, TX. 3 Teaching Faculty, Residency Training Committee Member, St. Vin- cent Charity Hospital Podiatric Surgical Residency Program, Cleveland, OH; Private Practice, Lake County Foot & Ankle Associates, Inc.; Fellow, American College of Foot and Ankle Surgeons; Diplomate, American Board of Podiatric Surgery, Mentor, OH. Copyright © 2008 by the American College of Foot and Ankle Surgeons 1067-2516/08/4702-0007$34.00/0 doi:10.1053/j.jfas.2007.12.009 118 THE JOURNAL OF FOOT & ANKLE SURGERY