Audit of acute Charcot’s disease in the UK: the CDUK study

Abstract

Aims/hypothesis We studied factors associated with the development and resolution of acute Charcot foot using a web-based observational study. centres. Of these, 36% of patients recalled an episode of relevant trauma in the preceding 6 months, while 12% had had surgery to the affected foot. In 101 (35%) cases, ulceration was present at registration and 20% of these had osteomyelitis. Non-removable off-loading devices were used at presentation in 35.4% of cases, with removable off-loading used in 50%. Data on resolution were available for 219 patients. The median time to resolution was 9 months in patients whose initial management included the use of non-removable off-loading, compared with 12 months in the remainder (p=0.001). Bisphosphonates were administered intravenously in 25.4% and orally in 19.4% of cases. The median time to resolution in patients who received bisphosphonates was 12 months and was longer than in those who did not (10 months, p=0.005). Conclusions/interpretation The median time to resolution was longer than in earlier series. Although limited by being observational and non-randomised, these data suggest that the use of non-removable off-loading at presentation may shorten the time to resolution. They provide no evidence to indicate that the use of bisphosphonates is beneficial.

Risk factors for Charcot foot

“…The risk factors for CF are not yet well established (7,11,12). The identification, prevention, and early manipulation of risk factors might delay the appearance and progression of CF.…”

Treatment of acute Charcot foot with bisphosphonates: a systematic review of the literature

“…On theoretical grounds, BPPs may have clinical benefit, but the results of published studies are inconclusive. On balance, treatment with BPPs appears rather ineffective and even deleterious for the resolution time of the acute stage [22,33]; moreover, data on long-term outcomes are not available. There is, therefore, currently little evidence to support the use of BPPs as part of the routine management of patients with diabetes complicated by acute CNO.…”

“…Nevertheless, Pakarinen et al [23] reported that zoledronate did not reduce the duration of immobilisation, and may have increased it. Moreover, the recent audit of acute diabetic CNO in the UK based on a multicentre observational study [33] also showed that the use of BPP was associated with a longer time to resolution. These findings suggest that there is currently no evidence that adding a BPP to immobilisation and off-loading confers long-term benefits.…”

An Evidence-Based Introduction to Charcot Foot Arthropathy

“…7,8,19 It is now appreciated that this patient population is also vitamin D deficient with subsequent osteoporosis. Peripheral neuropathy, osteoporosis, and morbid obesity appear to be very important predisposing risk factors.…”