Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker

Christensen, Tomas Møller; Gade-Rasmussen, Birthe; Pedersen, Lis W.; Hommel, Eva; Holstein, P.; Svendsen, Ole Lander

doi:10.1016/j.jdiacomp.2012.05.006

Cited by 56 publications

(112 citation statements)

References 34 publications

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“…The average age of patients in our investigation was 60.7 (±10.6) years, which corresponds to previously published studies [27–29]. …”

Section: Discussionsupporting

confidence: 88%

“…Treatment in an orthopedic device, such as a TCC to minimize mechanical forces on the bone, achieve a plantigrade, stable foot and prevent recurrent ulceration, is considered to be an important strategy in acute CN [6, 24, 27, 30–34]. Yet, there is a wide range of recommendations concerning initial treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, there is a wide range of recommendations concerning initial treatment. Some authors suggest non-weightbearing treatment during the first months to stop progression of deformity [27, 29, 34, 35]. In particular, they suggest that weightbearing should be prevented during the inflammation stage, to “cool down the foot” because of the risk that the unstable foot will continue to fracture [10, 35].…”

Section: Discussionmentioning

confidence: 99%

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Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

Renner

Wirth

Osterhoff

et al. 2016

BMC Musculoskelet Disord

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BackgroundCharcot neuropathic arthropathy (CN) is a chronic, progressive, destructive, non-infectious process that most frequently affects the bone architecture of the foot in patients with sensory neuropathy. We evaluated the outcome of protected weightbearing treatment of CN in unilaterally and bilaterally affected patients and secondarily compared outcomes in protected versus unprotected weightbearing treatment.MethodsPatient records and radiographs from 2002 to 2012 were retrospectively analyzed. Patients with Type 1 or Type 2 diabetes with peripheral neuropathy were included. Exclusion criteria included immunosuppressive or osteoactive medication and the presence of bone tumors. Ninety patients (101 ft), mean age 60.7 ± 10.6 years at first diagnosis of CN, were identified. Protected weightbearing treatment was achieved by total contact cast or custom-made orthosis. Ulcer, infection, CN recurrence, and amputation rates were recorded. Mean follow-up was 48 (range 1–208) months.ResultsPer the Eichenholtz classification, 9 ft were prodromal, 61 in stage 1 (development), 21 in stage 2 (coalescence) and 10 in stage 3 (reconstruction). Duration of protected weightbearing was 20 ± 21 weeks and 22 ± 29 weeks in patients with unilateral and bilateral CN, respectively. In bilaterally affected patients, new ulcers developed in 9/22 (41%) feet. In unilaterally affected patients, new ulcers developed in 5/66 (8%) protected weightbearing feet and 4/13 (31%) unprotected, full weightbearing feet (p = 0.036). The ulceration rate was significantly higher in bilaterally versus unilaterally affected patients with a protected weightbearing regimen (p = 0.004). Soft tissue infection occurred in 1/13 (8%) unprotected weightbearing feet and 1/66 (2%) protected weightbearing feet in unilaterally affected patients, and in 1/22 (4%) protected weightbearing feet of bilaterally affected patients. Recurrence and amputation rates were similar across treatment modalities.ConclusionsBilateral CN results in significantly more ulcers than unilateral CN and leads to slightly higher soft tissue infections. Protected weightbearing in an orthopedic device can reduce the risk for complications in acute CN of the foot and ankle.

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“…The average age of patients in our investigation was 60.7 (±10.6) years, which corresponds to previously published studies [27–29]. …”

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

Renner

Wirth

Osterhoff

et al. 2016

BMC Musculoskelet Disord

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“…at the time of the baseline (first) MRI study. Treatment consisted of permanent (except for bed-rest at night) and prolonged placing of the affected limb in a bi-valved removable total contact walking cast (TCC [24,25]). MRI follow up in most cases was stopped before complete disappearance of EESC.…”

Section: Methodsmentioning

confidence: 99%

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Chantelau

Antoniou

Zweck

et al. 2018

Diabetic Foot & Ankle

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Background: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. Study design: Retrospective observational study, chart review Material and methods: Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment. Only cases without concomitant infection or skin ulcer were chosen, in whom both was documented, onset of symptomatic foot swelling and patient compliance with cast treatment. Results: From 1994 to 2017, 45 consecutive cases in 37 patients were retrieved, with 95 MRI follow-up studies (1–6 per case, average interval between studies 13 weeks). Decreasing EESC was documented in 66/95 (69%) follow-up studies. However, 29/95 (31%) studies revealed temporarily increasing, migrating or stagnating EESC. Conclusion: EESC on MRI disappear in response to prolonged offloading and immobilizing treatment; however, physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images. Conventional MRI is useful for surveillance of active-stage Charcot foot recovery.

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“…Wie lange die Ruhigstellung aufrechterhalten werden muss, ist nicht eindeutig geklärt [55], aber eine mehrmonatige Ruhigstellung ist zumeist erforderlich. Wesentlich ist der dauerhafte Rückgang der klinischen Zeichen.…”

Section: Therapieunclassified

Diabetisches Fußsyndrom

Hochlenert¹,

Engels

Rümenapf

et al. 2015

Diabetologe

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Diese Fortbildungseinheit steht Ihnen als e.CME und e.Tutorial in der Springer Medizin e.Akademie zur Verfügung. -e.CME: kostenfreie Teilnahme im Rahmen des jeweiligen Zeitschriftenabonnements -e.Tutorial: Teilnahme im Rahmen des e.Med-Abonnements ZertifizierungDiese Fortbildungseinheit ist mit 3 CMEPunkten zertifiziert von der Landesärzte-kammer Hessen und der Nord rheinischen Akademie für Ärztliche Fort-und Weiterbildung und damit auch für andere Ärzte-kammern anerkennungsfähig. Hinweis für Leser aus ÖsterreichGemäß dem Diplom-Fortbildungs-Programm (DFP) der Österreichischen Ärzte-kammer werden die in der e.Akademie erworbenen CME-Punkte hierfür 1:1 als fachspezifische Fortbildung anerkannt. ZusammenfassungDas diabetische Fußsyndrom (DFS) ist eine lebenslange Komplikation des Diabetes, die Leben und Mobilität des Patienten bedroht sowie in inaktiven und aktiven Phasen verläuft. Etwa 15% der Menschen mit Diabetes erleiden im Laufe ihres Lebens ein DFS. Pro Jahr entwickelt sich bei 2-4% der Menschen mit Diabetes ein aktives DFS. Ein Großteil der Ausgaben für Diabetes entfällt auf das DFS. Die Betreuung erfolgt interdisziplinär; der Revaskularisation kommt eine besondere Rolle in der Amputationsvermeidung zu. Die Schuhversorgung und die podologische Betreuung spielen bei der Vermeidung des Übergangs in eine aktive Krankheitsphase eine wichtige Rolle. Die grundsätzlich vorhandene reduzierte Sensibilität und Schmerzwahrnehmung an den Füßen bedingen Verhaltensweisen des Patienten, die dem Erhalt der Gesundheit entgegenstehen. Kommunikation und eingesetzte Maßnahmen müssen darauf ausgerichtet sein. Schlüsselwörter Diabetes · Fußulkus, diabetisch · Diabetische Neuropathien · Druck · Register CME Zertifizierte Fortbildung Redaktion R. Landgraf, München 151 Der Diabetologe 2 · 2015 | CME Lernziele Nach der Lektüre dieses Beitrags … F sind Sie in der Lage, ein diabetisches Fußsyndrom (DFS) und das daraus resultierende Risiko zu erkennen. F kennen Sie die zugrunde liegenden Ursachen und Erkrankungen. F können Sie die wesentlichen Elemente der Behandlung beschreiben. F wissen Sie, welche Elemente der interdisziplinären Zusammenarbeit notwendig sind. Übersicht Das DFS bezeichnet eine Gruppe von Komplikationen des Diabetes mellitus, deren Gemeinsamkeit in einem hohen Risiko gravierender Schäden am Fuß bei Ausbleiben warnender Schmerzen besteht. Die Schäden betreffen [1]: F Haut (Ulzera) und F Stützapparat (Charcot-Fuß). Identische Krankheitsbilder entstehen bei Menschen mit Neuropathien anderer Genese. Die Auswirkungen der Neuropathie auf den Fuß beinhalten sensible ("loss of protective sensation"), motorische (muskuläre Dysbalancen mit Überwiegen proximal gelegener Muskelgruppen), autonome (Reduktion der Schweißproduktion) und psychologische Aspekte [2, 3]. Die Diagnosestellung einer Neuropathie ist wichtig, um die Schutzbedürftigkeit des Patienten eindeutig festzulegen. Eingesetzt werden Stimmgabel, Monofilament-, "Pinprick"-Test [4], Temperaturdiskrimination, Muskeleigenreflex-und weitere Tests. Das Ausmaß der Hypästhesie ...

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Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker

Cited by 56 publications

References 34 publications

Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Diabetisches Fußsyndrom

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