Long-term follow-up in diabetic Charcot feet with spontaneous onset.

Abstract

A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Long-Term Follow-Up in Diabetic Charcot Feet With Spontaneous OnsetOBJECTIVE -To assess the long-term results after Charcot breakdown with spontaneous onset in diabetic feet.RESEARCH DESIGN AND METHODS -This study was retrospective. A total of 115 patients (140 feet), 107 with acute deformity and 8 with chronic Charcot deformity, were followed for a median of 48 months (range 6-114). The routine treatment for acute cases was a weight-off regimen with crutches and foot protection with therapeutic shoes until skin temperature had normalized followed by increased weightbearing and the use of bespoke shoes or modification of conventional shoes.RESULTS -The incidence of Charcot deformity was 0.3%/year in the diabetic population investigated. About half of the patients were active in their jobs. Major complications were encountered in 5 (4%) of the patients that required surgical intervention: arthrodesis for unstable malaligned ankles in 3 subjects (1 bilaterally) and major amputation in 2 subjects for unstable ankle and pressure sores. Minor complications were recorded in 43% of subjects: new attacks of Charcot breakdown in 41 patients (36%) and/or foot ulceration in 43 patients (37%) that required minor surgical procedures for 11 patients. All healed except in 2 patients: 1 patient died before the Charcot fractures had healed, and 1 patient died with an unhealed ulcer. No patient lost the ability to walk independently.CONCLUSIONS -Major surgical procedures in only 4% were particularly related to patients with Charcot deformities in the ankle. Minor complications were recorded in about half of the patients. Lifelong foot care is required for diabetic patients with Charcot feet.

Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre

“…Other studies have similarly reported that a certain percentage of diabetic patients with Charcot arthropathy had a previous history of foot problems such as ulcer, surgery and/or amputation of the foot complex, along with a loss of protective sensation. (12,13,17) Foot ulcer in diabetic patients with loss of protective sensation commonly occurs at the plantar aspect because of the abnormal high plantar pressure. Delayed management and the absence of adequate pressure offloading of the foot ulcer may further delay wound healing, instigate infection and perpetuate the progression of foot deformity.…”

Charcot neuroarthropathy in diabetes mellitus

“…The reported incidence and prevalence of CN varies between 0.1% to 0.4% of diabetic populations [24,25,26,27]. In one of the largest series published, 101 cases were found among 68000 consecutive diabetic patients between 1947 and 1970, giving an incidence of 1:680 [24].…”

Charcot Ankle Arthropathy in CMT1A Exacerbated by Type 2 Diabetes Mellitus

“…Today, diabetes mellitus is the leading cause of a Charcot joint 13 . Though epidemiological data is weak, clinically overt Charcot joint is likely uncommon in large diabetes populations (incidence of 0.2 to 0.3%) 14,15 , but more frequent in populations of diabetic neuropathy reported from subspecialty clinics and radiologic surveys of patients with diabetic neuropathy [16][17][18] . In this patient, it is impossible to differentiate aspects of sensory and motor dysfunction into discrete phenomena caused by diabetic neuropathy versus CMT1A.…”