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Neuroartropatia de Charcot

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Updated Sep 2026
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O que você está sentindo

A neuroartropatia de Charcot afeta pessoas que perderam parte da sensibilidade nos pés, geralmente em decorrência do diabetes. Como as articulações não conseguem perceber a tensão da forma correta, caminhar e ficar em pé podem causar danos silenciosos. A articulação fica inchada, quente e vermelha, e o pé pode começar a mudar de forma. Muitas pessoas sentem pouca dor no início, o que contribui para que essa condição passe despercebida.

Quando há desconforto, ele costuma estar localizado no meio do pé ou no tornozelo. Frequentemente piora após ficar muito tempo em pé, podendo ser mais intenso à noite ou ao acordar. O repouso tende a aliviar os sintomas, mas o inchaço pode demorar para desaparecer. À medida que o pé muda de formato, tarefas cotidianas tornam-se mais difíceis: os sapatos podem machucar ou não servir mais, ficar em pé na bancada para cozinhar torna-se cansativo, e caminhar até a caixa de correio ou até as lojas pode causar instabilidade. Algumas pessoas desenvolvem o chamado “pé em mata-borrão”, em que o arco se achatou e colapsou, e os pontos de pressão podem se romper e formar úlceras na sola.

Seu cirurgião identifica o problema ao ouvir seus sintomas e examinar seu pé, comparando o que você sente com os achados clínicos. Caso sua descrição e o exame não coincidam perfeitamente, exames complementares como tomografia computadorizada ou ressonância magnética podem ajudar a determinar a causa. Os ossos do pé afetado também podem tornar-se mais finos, aumentando o risco de pequenas fraturas na própria articulação.

Se você tem diabetes e percebe que o pé está quente, inchado e com pouca ou nenhuma dor, vale a pena procurar avaliação médica prontamente. Um diagnóstico precoce oferece a melhor chance de manter a estabilidade do seu pé.

O que está realmente acontecendo

A neuroartropatia de Charcot ocorre quando uma articulação perde a proteção que a sensibilidade normalmente oferece. Articulações saudáveis enviam sinais de alerta quando estão sendo sobrecarregadas; assim, a pessoa descansa, troca de calçado ou retira o peso do local dolorido. Quando esses sinais não existem, a articulação continua recebendo carga. Pequenos traumas se acumulam, e o osso começa a se degradar e a mudar de forma.

Parecem ocorrer dois processos dentro da articulação. O primeiro é o desgaste sem o sistema de alerta habitual: como não se sente a sobrecarga, a pessoa continua caminhando sobre uma articulação que, em alguém com sensibilidade normal, seria mantida em repouso. O segundo é a alteração no fluxo sanguíneo dentro do osso, o que pode enfraquecê-lo a partir do interior. Em um pé de Charcot ativo, as células responsáveis por degradar o osso velho tornam-se mais ativas, enquanto as células que formam o osso novo não acompanham esse ritmo. O osso fica mais fino e fraco, motivo pelo qual pequenas fraturas podem ocorrer na própria articulação.

As articulações mais frequentemente afetadas são as do meio do pé e do tornozelo, onde os ossos e ligamentos normalmente mantêm tudo alinhado de forma estável. Os ligamentos são faixas resistentes que conectam os ossos e garantem o alinhamento da articulação durante a caminhada. À medida que o osso amolece e os ligamentos se esticam, essa estrutura começa a ceder. O arco do pé pode achatar-se e colapsar na forma de “pé em mata-borrão” descrita anteriormente; as articulações também podem sair do alinhamento. Como quase não há dor para servir de aviso, os danos se acumulam silenciosamente até que o pé mude de forma ou a pele se rompa.

Ninguém compreende exatamente por que isso acontece; provavelmente mais de um mecanismo está envolvido. O que importa para você é o seguinte: uma articulação incapaz de sentir danos não consegue se proteger; portanto, o inchaço, o aquecimento e a alteração de forma que você percebe são sinais de que a articulação tem sido silenciosamente sobrecarregada.

O que podemos fazer a respeito

O primeiro passo é retirar o peso das articulações afetadas, para que não fiquem sobrecarregadas. Podemos sugerir alterações nas suas atividades diárias, bem como o uso de órteses – dispositivos colocados dentro ou sobre os sapatos para dar suporte e proteger o pé. As órteses podem ter um impacto real na funcionalidade do pé no dia a dia. A fisioterapia tem como objetivo manter seus movimentos de forma segura, protegendo as articulações que perderam seus sinais de alerta. Testamos essa abordagem por um tempo razoável antes de considerar outras opções.

Medicamentos para alívio da dor e anti-inflamatórios podem ajudar a diminuir o desconforto a curto prazo. Utilizamos esses medicamentos em conjunto com as medidas acima, e não como substitutos delas.

Caso essas medidas não tragam melhoria suficiente, poderemos discutir a possibilidade de cirurgia. A principal opção é a artrodese, que consiste em unir os ossos afetados para que o pé ou tornozelo fiquem estáveis e mantenham sua forma ao suportar o peso do corpo. Um pé estável e plano no chão reduz bastante o risco de recorrência de úlceras e infecções na sola. Em alguns casos, usamos uma haste colocada através do tornozelo até o calcanhar para manter os ossos alinhados enquanto se unem. Quando é necessário suporte adicional, podemos utilizar enxerto ósseo – ou seja, osso retirado do próprio corpo do paciente para auxiliar na união dos ossos. A decisão cirúrgica é compartilhada, e discutiremos se esse procedimento se adequa ao seu pé e aos seus objetivos.

O que esperar

A neuroartropatia de Charcot é uma condição crônica. O inchaço e o aquecimento no pé ativo geralmente diminuem ao longo de semanas ou meses, especialmente após suspender o carregamento de peso na articulação. Contudo, as alterações na forma do pé tendem a permanecer. Sem tratamento, a articulação continua recebendo cargas que o paciente não consegue sentir, e os danos se acumulam silenciosamente até que o pé se torne instável ou a pele se rompa formando úlceras.

Com um cuidado bem gerenciado, muitos pés permanecem estáveis e utilizáveis. As órteses e outras medidas não cirúrgicas podem fazer uma grande diferença no funcionamento diário do pé. Quando a cirurgia é necessária, a fusão dos ossos afetados geralmente resulta em um pé estável; nos casos de reconstrução do retropé, os ossos se unem com sucesso em mais de 80% dos casos. No geral, a cirurgia para corrigir deformidades graves proporciona estabilidade em 93% dos pacientes. A maioria das pessoas submetidas a esse tipo de cirurgia relata melhor alívio da dor e melhor função, e fica satisfeita com o resultado por anos depois.

É justo dizer que a cirurgia em um pé com perda de sensibilidade é desafiadora. Os ossos às vezes não se unem, e podem ocorrer infecções ou problemas na cicatrização, especialmente em pessoas com diabetes, má circulação na pele ou que fumam. A seleção criteriosa dos pacientes é fundamental; a cirurgia geralmente é uma opção de resgate para pés que não melhoraram com outros tratamentos. Em poucos casos, não é possível salvar o membro, sendo então discutida a amputação.

O que se pode esperar, de forma realista, é o seguinte: com diagnóstico precoce, proteção contra sobrecarga e uma abordagem multidisciplinar, a maioria dos pés consegue permanecer estável e confortável. Quanto mais cedo a doença for identificada, maior será a preservação da forma e da função do pé.

Quando procurar ajuda médica

Na neuroartropatia de Charcot, os sinais de alerta não são os habituais. Um pé quente, inchado e vermelho, com pouca ou nenhuma dor, é o sinal mais importante; ele deve ser avaliado imediatamente, em vez de se esperar para ver se melhora por conta própria. Isso é ainda mais relevante em pacientes diabéticos, pois um pé sem sensibilidade não consegue alertar sobre danos da forma adequada. Procure um especialista se uma úlcera no pé não cicatrizar, se a forma do pé mudar ou se você notar dormência ou formigamento novos nos pés. Dirija-se ao pronto-socorro se o pé ficar subitamente muito dolorido, extremamente inchado ou se a pele se romper com vermelhidão que se espalha, pois esses sintomas podem indicar um problema que exige atendimento no mesmo dia.

Reviewed by AI synthesis (v2) — pending human review · 9 September 2026.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Anatomy & Pathophysiology

Bony Anatomy

  • The ankle mortise is formed by the tibial plafond, medial malleolus, and lateral malleolus [3].
  • The ankle mortise articulates with the dome of the talar body [3].
  • The talar dome is wider anteriorly and narrower posteriorly [3].
  • The ankle mortise widens 1 to 1.5 mm during motion from plantar flexion to dorsiflexion [3].
  • Medial and superior clear spaces appear wider with the foot in plantar flexion [3].
  • The distal fibula has a convex medial surface that articulates with the concave incisura fibularis of the distal lateral tibia [3].
  • The fibula rotates approximately 2 degrees within the incisura during ankle motion and ambulation [3].
  • Ankle dorsiflexion results in external rotation and proximal translation of the fibula [3].
  • The primary functions of the foot and ankle are to provide weight-bearing support and forward ambulation [3].

Ligamentous Anatomy

  • The lateral ankle ligaments function as restraints to varus and inversion forces at the ankle [3].
  • The anterior talofibular ligament (ATFL) originates from the anteroinferior aspect of the lateral malleolus, 1 cm proximal to its tip, and extends to the lateral aspect of the talar neck [3].
  • The calcaneofibular ligament (CFL) extends from the tip of the lateral malleolus to the lateral aspect of the calcaneus [3].
  • The posterior talofibular ligament (PTFL) extends from the posterior lateral malleolus to the posterolateral talus [3].
  • The ATFL is the weakest ankle ligament [3].
  • The PTFL is the strongest ankle ligament [3].
  • The distal tibiofibular joint (ankle syndesmosis) and fibula provide stability against lateral talar translation [3].
  • The deltoid ligament complex is the primary ankle stabilizer during stance [3].
  • The deep deltoid ligament extends from the apex of the medial malleolus to the medial talar body [3].
  • The deep deltoid ligament functions primarily to resist lateral talar translation and external rotation [3].
  • The posterior deep deltoid is the most important component of the deep deltoid ligament [3].
  • The superficial deltoid ligament extends from the distal medial malleolus to the navicular bone, sustentaculum tali of the calcaneus, medial talus, and spring ligament [3].
  • The superficial deltoid ligament functions primarily to resist valgus and eversion ankle forces [3].
  • The deltoid ligament consists of superficial and deep layers, with at most six bands, of which only three are constant: the tibionavicular ligament, tibiospring ligament, and deep posterior tibiotalar ligament [8].
  • The superficial layer of the deltoid ligament originates from the anterior malleolus and inserts into the navicular, neck of the talus, sustentaculum tali, and posteromedial talar tubercle [8].
  • The tibiocalcaneal portion of the superficial deltoid ligament is the strongest component and resists eversion of the calcaneus [8].
  • The deep portion of the deltoid ligament is organized into two short, thick, discrete bands: the anterior and posterior deep tibiotalar ligaments [8].
  • The anterior and posterior deep tibiotalar ligaments are intra-articular but extrasynovial [8].
  • The deep posterior band comprises the largest band of the deltoid complex [8].
  • The anterior deep tibiotalar ligament arises from the anterior malleolus and attaches to the medial aspect of the talus [8].
  • The posterior deep tibiotalar ligament originates from the posterior malleolus and inserts on the medial body of the talus [8].
  • The deltoid ligament has a rich vascular supply from three extraosseous sources: the medial tarsal artery, posterior tibial artery, and tibialis anterior artery [8].
  • The deltoid ligament also has an intraosseous vascular supply from either the talus or the medial malleolus [8].
  • The deep deltoid ligament has the highest load to failure at 713.8 N ± 69.3 compared with the lateral collateral ligaments [8].
  • The dominant mode of failure for the deep deltoid ligament is an intrasubstance rupture near its talar insertion [8].
  • The dominant mode of failure for the superficial deltoid ligament is at its insertion on the anterior malleolus [8].

Biomechanics

  • The ankle joint is responsible for most sagittal plane motion of the foot and ankle [3].
  • Ankle plantar flexion ranges from 23 to 48 degrees [3].
  • Ankle dorsiflexion ranges from 10 to 23 degrees [3].
  • The ankle joint also contributes to inversion, eversion, and rotation [3].
  • A simplified model of the ankle joint has a horizontal axis from anteromedial to posterolateral [3].
  • A simplified model of the ankle joint has a coronal axis from superomedial directed distally and laterally to the tip of the fibula [3].
  • The deltoid ligament, specifically the tibiocalcaneal ligament, primarily prohibits eversion and abduction [8].
  • The deep deltoid ligament, primarily the deep posterior tibiotalar ligament, resists external rotation when the foot is dorsiflexed [8].
  • The deep deltoid ligament is responsible for the greatest restraint against lateral translation [8].
  • Valgus tilting of the talus within the mortise requires complete rupture of both the superficial and deep deltoid ligaments [8].

Neurovascular Anatomy

  • The superficial peroneal nerve penetrates the deep fascia and lies subcutaneously 8 to 10 cm proximal to the tip of the lateral malleolus, anterior to the subcutaneous border of the fibula shaft [6].
  • The deep peroneal nerve accompanies the anterior tibial artery between the tendons of the anterior tibial and extensor digitorum longus muscles [6].
  • The deep peroneal nerve lies just lateral to the anterior tibial artery and just lateral to the extensor hallucis longus tendon [6].
  • The saphenous nerve is located just medial or posterior to the saphenous vein in a slightly deeper plane, 3 to 5 cm proximal to the tip of the medial malleolus [6].
  • The anterior tibial artery can usually be palpated beneath the superior extensor retinaculum 4 to 5 cm proximal to the distal articular surface of the tibia [6].
  • The peroneal tendons and superficial peroneal nerve are at the highest risk during intramedullary nailing of distal fibular fractures [11].
  • An accessory incision for arthroscopic repair of the lateral ligament should not surpass 22 mm distance from the lateral malleolus in the anterior direction to avoid damaging the superficial peroneal nerve [11].

Fracture Classification

  • The Danis–Weber Type A classification describes a transverse fracture of the fibula below the tibiofibular syndesmosis, sometimes associated with an oblique or vertical fracture of the medial malleolus [7].
  • The Danis–Weber Type B classification describes an oblique fracture of the fibula in the sagittal plane at the level of the syndesmosis, often accompanied by an avulsion injury on the medial side [7].
  • The Danis–Weber Type C classification describes a fracture above the level of the syndesmosis, indicating that the tibiofibular ligament and part of the interosseous membrane must have been torn [7].
  • To achieve a reduced ankle, the fibula must be restored to its full length [7].
  • To achieve a reduced ankle, the talus must sit squarely in the mortise with no tilt [7].
  • To achieve a reduced ankle, the medial joint space must be restored to its normal width [7].
  • To achieve a reduced ankle, there must be no tibiofibular diastasis [7].

Investigations

General Imaging Principles

  • Advanced imaging is often helpful in diagnosis when combined with a thorough clinical examination [15].
  • MRI is sensitive for all osteochondral lesions of the ankle, but the edema pattern frequently overestimates the severity of injury [12, 13].
  • Linear fluid signal deep to subchondral bone on MRI indicates an unstable osteochondral injury [12, 13].
  • MRI has a sensitivity of 92% for predicting stable versus unstable osteochondral lesions [12, 13].

Osteochondral Lesions

  • Osteochondral lesions are seen in up to 70% of ankle sprains and 75% of ankle fractures [12, 13].
  • The most common location for osteochondral lesions is the medial talar dome [12, 13].
  • Modern data prove that the most common location for medial talar dome osteochondral lesions is central [12, 13].
  • Medial talar dome osteochondral lesions are larger and deeper than lateral lesions [12, 13].
  • The most common location for lateral talar dome osteochondral lesions is central [12, 13].
  • Lateral talar dome osteochondral lesions are more often unstable, displaced, or symptomatic than medial lesions [12, 13].
  • AP, mortise, and lateral weight-bearing ankle x-rays may not demonstrate subtle osteochondral lesions [12, 13].
  • CT scan is helpful for determining the integrity of subchondral bone and identifying cysts in osteochondral lesions [12, 13].

Ankle Fractures and Syndesmosis

  • MRI lacks additional diagnostic value for stability assessment of the ankle mortise in supination-external rotation-type ankle fractures [16].
  • Preoperative computed tomography scans are used in operative planning for malleolar ankle fractures [16].
  • Malreduction of the posterior malleolus is significantly more likely to lead to malreduction of the syndesmosis [16].

Ligamentous and Soft Tissue Pathology

  • MRI is used for the evaluation of posterior tibial tendon dysfunction with relevance to clinical staging [1].
  • MRI is used for the evaluation of anterolateral soft tissue impingement of the ankle [1, 17].
  • MRI is used for the evaluation of osteochondral lesions of the talus [1].
  • MRI is used for the diagnosis of ligamentous and chondral pathology in the ankle [1].
  • MRI and stress radiography are used in the evaluation of chronic lateral ankle instability [1].
  • MRI is used for pre-operative evaluation of the anterior talofibular ligament in chronic ankle instability [1].
  • MRI findings are associated with symptoms in patients with chronic ankle sprain [1].
  • MRI is used for the imaging evaluation of traumatic ligamentous injuries of the ankle and foot [1].
  • MRI is used for the musculotendinous imaging of the ankle [1].
  • CT and MR imaging are used for the evaluation of the postoperative ankle and foot [1].
  • MRI is used for the diagnosis of plantar plate injury with reference to intraoperative findings [1].
  • MRI is compared to physical examination for the diagnosis of syndesmotic injury after lateral ankle sprain [2].
  • Peroneal tendon abnormalities are identified on routine magnetic resonance imaging of the foot and ankle [14].

Entrapment Neuropathies

  • MR imaging is used for the evaluation of entrapment neuropathies of the lower extremity, including the knee, leg, ankle, and foot [18].
  • Point-of-care ultrasonography is used in the diagnosis and management of superficial peroneal nerve entrapment [18].

References

[1] Campbell S Operative Orthopaedics 4 Volume Set. REFERENCES > FOOT AND ANKLE.

[2] Campbell S Operative Orthopaedics 4 Volume Set. REPAIR OF ACUTE RUPTURE OF LATERAL LIGAMENTS > ACUTE ANKLE LIGAMENT INJURIES, CHRONIC ANKLE INSTABILITY.

[3] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > BIOMECHANICS OF THE FOOT AND ANKLE.

[6] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > ANKLE BLOCK.

[7] Apley And Solomon S Concise System Of Orthopaedics And Trauma. Treatment.

[8] Orthopaedic Knowledge Update Sports Medicine 6. Ankle and Foot Injuries and Other Disorders > Ankle Sprains > Medial Ankle Injury.

[11] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Foot and Ankle Anatomy and Biomechanics > Annotated References.

[12] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > OSTEOCHONDRAL LESIONS.

[13] Miller S Review Of Orthopaedics. OSTEOCHONDRAL LESIONS.

[14] Campbell S Operative Orthopaedics 4 Volume Set. MULTIPLE Z-PLASTY RELEASE OF A CONGENITAL RING > PERONEAL TENDONS.

[15] Orthopaedic Knowledge Update Sports Medicine 6. Ankle and Foot Injuries and Other Disorders > Summary.

[16] Orthopaedic Knowledge Update Trauma. Ankle Fractures > Annotated References.

[17] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC EXAMINATION AND DEBRIDEMENT OF THE ANKLE JOINT > IMPINGEMENT.

[18] Campbell S Operative Orthopaedics 4 Volume Set. COMBINED HAMMER TOE AND MALLET TOE DEFORMITY WITH ASSOCIATED DOUBLE CORNS > REFERENCES > TARSAL TUNNEL SYNDROME.

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i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.