Radiographic and functional results in the treatment of early stages of Charcot neuroarthropathy with a walker boot and immediate weight bearing

Abstract

BackgroundOne of the most common gold standards for the treatment of Charcot neuroarthropathy (CN) in the early Eichenholtz stages I and II is immobilization with the total contact casting and lower limb offloading. However, the total amount of offloading is still debatable.ObjectivesThis study evaluates the clinical and radiographic findings in the treatment of early stages of CN (Eichenholtz stages I and II) with a walker boot and immediate total weight-bearing status.MethodsTwenty-two patients with type 2 diabetes mellitus (DM) and CN of Eichenholtz stages I and II were selected for non-operative treatment. All patients were educated about their condition, and full weight bearing was allowed as tolerated. Patients were monitored on a fortnightly basis in the earlier stages, with clinical examination, temperature measurement, and standardized weight-bearing radiographs. Their American Orthopedic Foot and Ankle Society (AOFAS) scores were determined before and after the treatment protocol.ResultsNo cutaneous ulcerations or infections were observed in the evaluated cases. The mean measured angles at the beginning and end of the study, although showing relative increase, did not present a statistically significant difference (p > 0.05). Mean AOFAS scores showed a statistically significant improvement by the end of the study (p < 0.005).ConclusionThe treatment of early stages of CN (Eichenholtz stages I and II) with emphasis on walker boot and immediate weight bearing has shown a good functional outcome, non-progressive deformity on radiographic assessment, and promising results as a safe treatment option.

Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review

“…Three non‐controlled studies concluded that a non‐removable TCC or walker boot can be effective and safe for weight‐bearing treatment to prevent ulcers in acute Charcot's neuro‐osteoarthropathy .…”

Multidisciplinary Approach for the Management and Treatment of Diabetic Foot Infections with a Resorbable, Gentamicin-Loaded Bone Graft Substitute

“…Depth of the ulceration as well as presence of an infection and/or ischemia are key factors to predict the risk of amputation according to the well-accepted Wagner/Armstrong classification [7,8]. The incidence of Charcot neuropathy among diabetic patients is reported to be up to 7.5% [9,10]. Foot ulcers are the most common foot problem in diabetic patients [3] and are often associated with Charcot neuropathy or osteomyelitis [11,12].…”

Systematic review of techniques to monitor remission of acute Charcot neuroarthropathy in people with diabetes

“…11,[21][22][23][24][25]38 In the second group, the study's primary aim was to report outcomes of CN but they may also describe monitoring techniques used, thus providing data to answer our fifth objective on whether monitoring techniques influence outcomes. [6][7][8][9][10][12][13][14][15][16][26][27][28][29][30][31][32][33][34][35][36][37] 3.3 | Techniques used in the monitoring of CN Armstrong et al 38 Level 3…”