Charcot Arthropathy of the Foot and Ankle in Patients With Idiopathic Neuropathy

Bariteau, Jason T.; Tenenbaum, Shay; Rabinovich, Alexander; Brodsky, James W.

doi:10.1177/1071100714543649

Cited by 36 publications

(42 citation statements)

References 17 publications

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“…Grear stated in his article that the orthopedic community has to be more aware of the relationship of these two diseases 2013[ 17 ]. Charcot feet due to idiopathic neuropathy represent another entity, which just recently had been published and has not been thoroughly investigated[ 18 ]. In our opinion, there could be a high number of undiagnosed patients specifically in the early stages of CN in patients without diabetes mellitus, because many physicians combine Charcot neuroathropathy strictly to diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Clinical benefit and improvement of activity level after reconstruction surgery of Charcot feet using external fixation: 24-months results of 292 feet

Illgner

Budny

Frohne

et al. 2014

BMC Musculoskelet Disord

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BackgroundReconstruction of Charcot feet remains a surgical challenge. The goal of this study was to investigate safety and clinical benefit from reconstruction of Charcot feet using an external fixator. There is limited valid data regarding long-term outcomes for Charcot foot procedures.MethodsIn a retrospective study, 292 Charcot feet (282 patients) undergoing reconstructive procedures in our clinic from 1996–2010 were included (93 female, 189 male, mean age 57.9 years). Average follow-up was 24.1 months. Exclusion criteria were previous major amputation on the same side. All patients underwent surgery using a Hoffmann II external fixator for six to eight weeks with offloading. The fixator was then removed, and a customized AFO with full weight bearing was applied for another 11 months. After one year, patients received customized orthopedic shoes.ResultsInitial amputations were avoided. Patient activity improved significantly by more than 1 level (SD 0.67, p < .001) according to the Hoffer activity score for lower limb amputees. The most common minor complication was persistent or recurrent ulceration in 67 feet (23%). Secondary amputation (after failure of external fixation) was required in only 12 patients (6.2%). Orthopedic shoes were used by approximately 34% of patients 18 months after surgery.ConclusionsReconstructive surgery of Charcot feet using external fixation is a safe and economically feasible procedure. Activity levels improved significantly by more than 1 level (p < 0.01), severe complications were rare, and secondary amputation was required in only 12 patients (6.2%) of a high-risk patient population. Use of an external fixator offers the advantage that all extraneous material is removed after six weeks; thus, there is no risk of broken screws or plates and the associated potential complications.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-392) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Clinical benefit and improvement of activity level after reconstruction surgery of Charcot feet using external fixation: 24-months results of 292 feet

Illgner

Budny

Frohne

et al. 2014

BMC Musculoskelet Disord

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“…The acute Charcot foot has also recently been reported as a complication of the neuropathy of rheumatoid disease . Other causes are rare and include other causes of neuropathy , traumatic denervation and syringomyelia.…”

Section: Potential Predisposing Factors In Diseases Other Than Diabetesmentioning

confidence: 99%

Charcot foot syndrome

Jeffcoate

2015

Diabet. Med.

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Charcot foot syndrome is an uncommon complication of diabetes but is potentially devastating in its consequences. Outcome is made worse by widespread professional ignorance leading to delayed diagnosis, but it is also hampered by lack of understanding of its causes and lack of treatments with proven effectiveness, other than offloading. There remains a desperate need for studies into its causes as well as comparative audit and trials designed to determine the best treatment for this difficult condition. Such work can probably only be effectively carried out through the establishment of multicentre networks. Nevertheless, improved understanding in recent years of the likely role of inflammatory pathways has raised awareness of the multiple ways in which the effects of neuropathy may be manifest in the development of the Charcot foot. This awareness is also leading to the realization that similar processes may conceivably contribute to the refractoriness of other foot diseases in diabetes, including both chronic unhealing ulcers and osteomyelitis.

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“…Descrita por Jean-Martin-Charcot em 1868, a artropatia de Charcot (AC) foi originalmente associada à sífilis terciária (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) . A utilização dos antibióticos na prática médica (início do século XX) reduziu drasticamente a incidência da sífilis no nosso meio e, em consequência, a ocorrência dos casos de AC passou a ser observada mais raramente (8) .…”

Section: Introductionunclassified

“…A utilização dos antibióticos na prática médica (início do século XX) reduziu drasticamente a incidência da sífilis no nosso meio e, em consequência, a ocorrência dos casos de AC passou a ser observada mais raramente (8) . Por outro lado, o desenvolvimento da insulina sintética propiciou melhor controle da doença e aumento da sobrevida dos pacientes diabéticos, criando condições para o desenvolvimento das complicações tardias dessa doença (5,6,8,11) . Atualmente, existe uma epidemia mundial de obesidade que está intimamente relacionada com o aumento alarmante na incidência do diabetes mellitus e, consequentemente, da AC (5,(11)(12)(13)(14) .…”

Section: Introductionunclassified

Evaluation of the prognosis of type IV Charcot arthropathy treatment

Chakkour

Neto

2018

Sci J Foot Ankle

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Objective: To evaluate the prognosis of specialized orthopedic treatment to obtain a functional foot and ankle in diabetic patients with neglected Charcot arthropathy (NCA). Methods: Sixty-five patients with NCA were treated in the period between 2000 and 2017, according to a systematized protocol adopted atour institution. Six patients (9%) were lost to follow-up, and the remaining 59 patients had a total of 63 affected extremities (four patients were bilaterally affected). The mean follow-up time was 72 months (range 12 to 132 months), and the mean age was 54 years (range 30 to 80 years). We considered the results satisfactory when the patient was able to walk independently, fully supporting the foot on the ground. We considered the results unsatisfactory when the affected extremity presented a frank instability and was deformed to the point that it was not possible to accommodate it in a stabilizing orthesis or support it during gait or when amputation was necessary. Results: We obtained an unsatisfactory result in 31 of the 59 patients (53%). Only 31 of the 63 extremities (49%) were considered functional after treatment. Conclusion: The prognosis of NCA treatment using the systematized treatment protocol is poor. Only half of the treated extremities were capable of plantar support and independent gait. Level of Evidence IV; Prognostic Studies; Case Series.

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Charcot Arthropathy of the Foot and Ankle in Patients With Idiopathic Neuropathy

Abstract: Level IV, retrospective case series.

Cited by 36 publications

References 17 publications

Clinical benefit and improvement of activity level after reconstruction surgery of Charcot feet using external fixation: 24-months results of 292 feet

Clinical benefit and improvement of activity level after reconstruction surgery of Charcot feet using external fixation: 24-months results of 292 feet

Charcot foot syndrome

Evaluation of the prognosis of type IV Charcot arthropathy treatment

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