Current Practice Patterns in the Treatment of Charcot Foot

Abstract

Treatment of Charcot foot osteoarthropathy has emerged as a major component of the American Orthopaedic Foot and Ankle Society (AOFAS) Diabetes 2000 Initiative. A two-part survey described treatment patterns and current footwear use of patients with Charcot osteoarthropathy of the foot and ankle. In the first part, 94 consecutive patients with a history of Charcot foot and ankle presenting for care were questioned on their foot-specific treatment and current footwear use. A history of diabetic foot ulcer was given by 39 (41%) patients, and an infection had been present in a foot of 20 (21%) patients. The initial treatment of the Charcot foot and ankle had been a total contact cast in 46 (49%) patients, and a pre-fabricated walking boot in 19 (20%). Charcot related surgery had consisted of 76 procedures in 46 (49%) patients. Sixty-three (67%) patients were currently using accommodative footwear (depth-inlay shoes in 46 [49%], custom shoes in 10 [11%], and CROW in 7 [7%] patients), and 72 (77%) were currently using custom accommodative foot orthoses. The second part of this study consisted of a questionnaire completed by 37 orthopaedic surgeons (members of AOFAS) interested in forming a Charcot Study Group. They treated an average of 11.8 patients having Charcot foot or ankle per month. Thirty (81%) used the Semmes-Weinstein 5.07 monofilament as a screening tool for peripheral neuropathy. For treatment of Eichenholtz Stage I, 29 (78%) used a total contact cast and 15 (41%) allowed weightbearing; for Stage II, 30 (81%) physicians used a total contact cast and 18 (49%) allowed weightbearing. Although the literature contains uniform recommendations for immobilization and non-weightbearing as treatment for the initial phases of Charcot arthropathy, the results of this benchmarking study reveal that currenl treatment is varied.

Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

“…Frykberg et al recommended a non-weightbearing period of 8–12 weeks to avoid trauma to the affected foot [34]. Other investigators allowed weightbearing when the foot was placed in a cushioned device [10, 36–38]. De Souza et al showed that protected weightbearing in a TCC does not initiate new foot ulcers in the treatment of a Charcot foot [10].…”

The Charcot Joint: A Modern Neurologic Perspective

“…2,4 Autonomic neuropathy is well known to alter vasoregulation, leading to increased bone reabsorption and osteopenia, allowing minor trauma to cause fractures, dislocation, and joint collapse. 2,8 One study of 261 patients with diabetes found abnormalities on cardiovascular autonomic testing in 6% to 31% of those without neuropathy, 16% to 45% with subclinical neuropathy, 22% to 59% with symptomatic neuropathy, and 67% to 100% with peripheral neuropathy and autonomic symptoms. 9 Support for this theory includes studies on peripheral circulation in patients with small fiber autonomic neuropathy, which showed increased blood flow in diabetics versus nondiabetics.…”

Charcot neuroarthropathy in diabetes mellitus

“…There have been various treatment regimens advocated by several authorities [89,90] with no single regimen emerging as the most effective. This is largely due to the paucity of randomised, double-blind, controlled trials looking into the most efficacious way of treating CN.…”