Conservative and surgical treatment of the chronic Charcot foot and ankle

Güven, Mehmet Fatih; Karabiber, Atakan; Kaynak, Gökhan; Öğüt, Tahir

doi:10.3402/dfa.v4i0.21177

Cited by 46 publications

(28 citation statements)

References 66 publications

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“…Most often, indications are recurrent ulcers, malalignement and soft tissue infection or even osteomyelitis. Procedures that are performed are simple ulcer debridements, open reductions, exostosectomies, arthrodesis with internal or external fixation, or finally amputations [8,14,[20][21][22][23]. Amputations can be divided into minor and major amputations with the latter being procedures above the ankle joint [24].…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up of conservative treatment of Charcot feet

Gratwohl

Jentzsch

Schöni

et al. 2021

Arch Orthop Trauma Surg

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Background Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially being treated conservatively, and to identify risk factors for reactivation and contralateral development of CN as well as common complications in CN. Methods A total of 184 Charcot feet in 159 patients (median age 60.0 (interquartile range (IQR) 15.5) years, 49 (30.1%) women) were retrospectively analyzed by patient chart review. Rates of limb salvage, reactivation, contralateral development and common complications were recorded. Statistical analysis was performed to identify possible risk factors for limb loss, CN reactivation, contralateral CN development, and ulcer development. Results Major amputation-free survival could be achieved in 92.9% feet after a median follow-up of 5.2 (IQR 4.25, range 2.2–11.25) years. CN recurrence occurred in 13.6%. 32.1% had bilateral CN involvement. Ulcers were present in 72.3%. 88.1% patients were ambulating in orthopaedic footwear without any further aids. Presence of Diabetes mellitus was associated with reactivation of CN, major amputation and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations. Conclusions With consistent conservative treatment of CN with orthopaedic footwear or orthoses, limb preservation can be achieved in 92.9% after a median follow-up of 5.2 years. Patients with diabetic CN are at an increased risk of developing complications and CN reactivation. To prevent ulcers and amputations, every effort should be made to make patients stop smoking. Level of Evidence III, long-term retrospective cohort study

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Section: Introductionmentioning

confidence: 99%

Long-term follow-up of conservative treatment of Charcot feet

Gratwohl

Jentzsch

Schöni

et al. 2021

Arch Orthop Trauma Surg

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“…Historically, the primary non-surgical treatment for Charcot has been immobilization and offloading, including splints, braces, orthosis, or casts, often nonweightbearing (7). Other non-surgical modalities of treatment, successful to varying degrees, include pharmacologic antiresorptive therapy (eg, bisphosphates, calcitonin) and bone growth stimulation utilizing ultrasonic, magnetic field, or direct current electrical bone growth stimulators (6,7,8).…”

Section: Discussionmentioning

confidence: 99%

A Multicenter, Retrospective, Case Series of Patients With Charcot Neuroarthropathy Deformities Undergoing Arthrodesis Utilizing Recombinant Human Platelet-derived Growth Factor With Beta-Tricalcium Phosphate

Loveland

McMillen

Cala

2021

The Journal of Foot and Ankle Surgery

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…It is suspected in a patient with an adequate blood supply to the affected foot that has a deep ulcer which would not heal after 6 weeks of appropriate wound care and off-loading [ 25 ]. Some diabetic patients who develop neuropathies or osteomyelitis but with little arterial disease may often benefit from surgical debridement or excision and/or prolonged antibiotic therapy for at least 4 weeks, based on the culture and sensitivity of biopsied bone tissue or the curettage of deep tissues [ 3 , 4 , 26 ]. Swab specimens, especially of incompletely debrided wounds provide less accurate results [ 1 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of the diabetic foot – to amputate or not?

Weledji

Fokam

2014

BMC Surg

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BackgroundDiabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches.DiscussionThe article debates the pros and cons of amputation of the diabetic foot. The thesis is that if the guidelines on the management of the diabetic foot are followed primary amputation is only necessary for the unsalvageable diabetic foot. This approach would reduce the incidence of lower limb amputations in diabetic patients.SummaryWe favour the argument that a structured clinical and vascular assessment would help clinical decision- making as to which patients to hospitalize, which to send for imaging, or for whom to recommend surgical interventions. Endovascular procedures are the future in the treatment of diabetic arterial disease and hence the diabetic foot.

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Conservative and surgical treatment of the chronic Charcot foot and ankle

Cited by 46 publications

References 66 publications

Long-term follow-up of conservative treatment of Charcot feet

Long-term follow-up of conservative treatment of Charcot feet

A Multicenter, Retrospective, Case Series of Patients With Charcot Neuroarthropathy Deformities Undergoing Arthrodesis Utilizing Recombinant Human Platelet-derived Growth Factor With Beta-Tricalcium Phosphate

Treatment of the diabetic foot – to amputate or not?

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