* Congenital insensitivity to pain
* Peripheral nerve injuries
* Diabetic neuropathy
* Chronic diseases of the spinal cord that lead to sensory disturbances of the limbs.
In myelomeningocele, absence of pain sensation is associated with flaccid paralysis and marked limitation of physical activity; thus, owing to associated severe osteoporosis, the bone and joint changes present a different picture.
The joints involved vary with the different etiologic conditions.
In congenital insensitivity to pain and diabetic neuropathy, the destructive changes occur primarily in the tarsal and metatarsal joints, less commonly in the ankle, and rarely in the knee.
In syringomyelia, the joints involved are those of the shoulder and elbow. In tabes dorsalis, the knee, hip, ankle, and thoracolumbar spine are frequent sites of the disease.
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