Charcot foot: Skin temperature as a good clinical parameter for predicting disease outcome

BackgroundCharcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors’ knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes.MethodsElectronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway.ResultsThe systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN.ConclusionsThis research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations.

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“…Most commonly, at the time of onset patients with both Type 1 or Type 2 diabetes have been diagnosed for a period >10 years [8,13,27-30]. …”

Section: Resultsmentioning

confidence: 99%

Developing an evidence‐based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro‐Arthropathy: a systematic review

Milne

Rogers

Kinnear

et al. 2013

Journal of Foot and Ankle Research

153

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“…Поскольку отек и гиперемия -это субъек-тивные параметры, разница температур яв- [49]. Повышение температуры кожи не всегда связано с наличием воспале-ния и может происходить вследствие раз-личных причин, например, под воздействи-ем внешних факторов или при диабетиче-ской полинейропатии.…”

Section: клинические критерииunclassified

Diabetic neuroosteoarthropathy: the modern approaches for diagnosis and immobilization period determination (review)

Kaminarskaya¹

2015

Endo Serg

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Диабетическая нейроостеоартропатия (ДНОАП) является редким, но тяжелым ос-ложнением диабетической полинейропатии. Это состояние, характеризующееся про-грессирующей деструкцией костей и суста-вов стопы, неизбежно приводит к выражен-ной деформации стоп. Причины развития ДНОАП не до конца ясны. Существуют убеди-тельные доказательства, что провоцирую-щим фактором ДНОАП является нераспоз-нанная травма, инфицированная язва или оперативное вмешательство на стопе. Распространенность ДНОАП среди пациен-тов с сахарным диабетом (СД), по данным разных авторов, составляет от 0,08 до 7,5%. (В некоторых работах были зафиксированы более высокие показатели распространен-ности ДНОАП: у 13% среди всех больных СД и у 29% пациентов с диабетической поли-нейропатией [1, 2]; однако эти цифры вызы-вают ряд вопросов, в том числе касающихся критериев постановки диагноза и формиро-вания выборки.)ДНОАП ассоциирована с высокой часто-той ампутаций и уровнем смертности. Согласно исследованию Pakarinen T.-K. и соавт., в котором был отслежен 41 пациент с острой ДНОАП, общая смертность соста- Endocrinology Research Centre, Moscow, Russian FederationДиабетическая нейроостеоартропатия -осложнение сахарного диабета, ассоциированное с высокой частотой ампутаций и уровнем смертности. Благодаря развитию методов диагностики сегодня стало возможным выявление диабетической нейроостеоартропатии на ранней рентген-негативной стадии. Лечение на данном этапе способно предотвратить развитие выраженной деструкции костного скелета стопы и формирование серьезных деформаций. Однако не существует единого подхода к диагностике рентген-негативной стадии диабетической нейро остео-артропатии. Также остается спорным вопрос о сроках иммобилизации пораженной конечности и методах определения завершения острой стадии диабетической нейроостеоартропатии. Данный обзор посвящен современному состоянию знаний о диагностике, классификации и критериях завершения активной стадии диабетической нейроостеоартропатии. Клю че вые сло ва: сахарный диабет, стопа Шарко, ранняя диагностика, МРТ.Diabetic neuroosteoarthropathy is complication of diabetes associated with high rates of amputations and mortality. The development of diagnostic methods may identify diabetic neuroosteoarthropathy at early X-ray negative stage before the development of radiographic changes. Treatment at this stage can prevent the development of progressive bone and joint deterioration. However, there is no unified approach to diagnose of X-ray negative stage. The timing of immobilization of the affected limb is still controversial among experts, and where is no objective methods for determining the completion of the acute stage of diabetic neuroosteoarthropathy. This review focuses on the current state of knowledge about the diagnosis, classification and criteria for completion of the active phase of diabetic neuroosteoarthropathy.

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“…In all evaluations, a thorough clinical examination was performed, including local temperature, skin abnormalities, and standardized radiographic evaluations. The walker boot was discontinued when patients had shown all three parameters (clinical, radiographic, and temperature measurement of comparative lower limbs) as described below:Clinical: no pain, warmth, erythema, or edema.Temperature: when the temperature difference between lower extremities had dropped to less than 2 ° C (21). …”

Section: Treatment Protocolmentioning

confidence: 99%

“…Temperature: when the temperature difference between lower extremities had dropped to less than 2 ° C (21). …”

Section: Treatment Protocolmentioning

confidence: 99%

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

Parisi

Godoy‐Santos

Ortiz

et al. 2013

Diabetic Foot & Ankle

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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.

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Charcot foot: Skin temperature as a good clinical parameter for predicting disease outcome

Cited by 45 publications

References 12 publications

Developing an evidence‐based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro‐Arthropathy: a systematic review

Developing an evidence‐based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro‐Arthropathy: a systematic review

Diabetic neuroosteoarthropathy: the modern approaches for diagnosis and immobilization period determination (review)

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

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