Cutaneous microvascular reactivity in Charcot neuroarthropathy: a systematic review and meta‐analysis

Abstract

Background To systematically evaluate the literature investigating the relationship between cutaneous microvascular reactivity in the foot of adults with diabetes-related Charcot neuroarthropathy compared to a non-Charcot adult control group. Methods A systematic search was conducted to June 2021 using the biomedical databases EBSCO Megafile Ultimate, Cochrane Library and EMBASE. Original research conducting comparative investigation of cutaneous microvascular reactivity in the foot of adults with diabetes and any pattern of acute or chronic Charcot neuroarthropathy and any non-Charcot adult control groups were included. A modified Critical Appraisal Skills Programme tool was used for quality appraisal. Cutaneous microvascular reactivity in diabetes-related Charcot neuroarthropathy data were synthesised and meta-analysis conducted where possible. Results The search strategy identified 1,684 articles, with seven eligible for inclusion. Included studies used various methodologies and equipment to assess cutaneous microvascular reactivity in 553 participants (162 with Charcot neuroarthropathy). Cutaneous microvascular reactivity in Charcot neuroarthropathy groups was impaired compared to uncomplicated diabetes groups. Meta-analysis investigating the difference in response to thermal hyperaemia demonstrated a significant difference in cutaneous microvascular reactivity between Charcot neuroarthropathy and peripheral neuropathy with a large, pooled effect size (SMD 1.46 95% CI: 0.89–2.02) and low heterogeneity (I2 = 4%, T2 = 0.01) indicating that the cutaneous microvascular response is more impaired in peripheral neuropathy than in Charcot neuroarthropathy. Conclusions Charcot neuroarthropathy is associated with greater cutaneous microvascular reactivity in the periphery relative to diabetes cohorts with diabetes-related peripheral neuropathy alone. It is unknown if this occurs prior to, or as a result of, Charcot neuroarthropathy.

Charcot foot: the unknown diagnosis and the unwilling treatment

“…2,9,10 It is thought that Charcot foot develops due to recurring micro-trauma to the foot with sensitive deficit (neurotraumatic theory), and sympathetic denervation with peripheral vasodilation and formation of arteriovenous shunting causing the increase of osteoclastic activity (neurovascular theory). 1,4,5,11 Their prevalence is increased with aging, obesity, neuropathy, foot trauma or surgery, increased haemoglobin A1c levels, renal failure, iron deficiency anaemia, osteoporosis, and rheumatoid arthritis. 2,5 Charcot foot is classified clinical, anatomical and radiologically.…”