Excess Cost and Healthcare Resources Associated With Delayed Diagnosis of Charcot Foot

Labovitz, Jonathan M.; Shapiro, Jarrod; Satterfield, V. Kathleen; Smith, Nathanael T.

doi:10.1053/j.jfas.2018.03.036

Cited by 13 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At present, the only accepted treatment modality is prolonged immobilization of the foot in a below-knee cast ( 3 ). This therapy causes a significant burden to the individual living with an active Charcot foot ( 4 ), as well as requiring significant resources for regular replacement of casts and provision of care ( 5 ). Yet, despite prolonged off-loading therapy, fracture healing is delayed, and nonunion is common.…”

Section: Introductionmentioning

confidence: 99%

Effect of Recombinant Human Parathyroid Hormone (1-84) on Resolution of Active Charcot Neuro-osteoarthropathy in Diabetes: A Randomized, Double-Blind, Placebo-Controlled Study

et al. 2021

View full text Add to dashboard Cite

Fractures in Charcot neuro-osteoarthropathy (CN) often fail to heal despite prolonged immobilization with below-knee casting. The aim of the study was to assess the efficacy of recombinant human parathyroid hormone (PTH) in reducing time to resolution of CN and healing of fractures. RESEARCH DESIGN AND METHODSPeople with diabetes and acute (active) Charcot foot were randomized (doubleblind) to either full-length PTH (1-84) or placebo therapy, both in addition to below-knee casting and calcium and vitamin D3 supplementation. The primary outcome was resolution of CN, defined as a skin foot temperature difference >2 C at two consecutive monthly visits. RESULTSMedian time to resolution was 5 months (95% CI 4, 12) in intervention and 6 months (95% CI 2, 9) in control. There was no significant difference in time to resolution between the groups (mixed-effects logistic regression; P 5 0.64). The hazard ratio of resolution was 0.84 (95% CI 0.41, 1.74; P 5 0.64), and the odds ratio of resolution by 12 months was 1.22 (0.90, 1.67; P 5 0.20) (intervention vs. control). On linear regression analysis, there were no significant differences in the effect of treatment on fracture scores quantitated on MRI scans (coefficient 0.13 [95% CI À0.62, 0.88]; P 5 0.73) and on foot and ankle X-rays (coefficient 0.30 [95% CI À0.03, 0.63]; P 5 0.07). CONCLUSIONSThis double-blind placebo-controlled trial did not reduce time to resolution or enhance fracture healing of CN. There was no added benefit of daily intervention with PTH (1-84) to below-knee casting in achieving earlier resolution of CN.Charcot neuro-osteoarthropathy (CN), or Charcot foot, is one of the most disabling complications of diabetic neuropathy (1,2). Simple trauma sets off uncontrolled inflammation and pathological fractures, resulting in severe foot deformity with an

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of Recombinant Human Parathyroid Hormone (1-84) on Resolution of Active Charcot Neuro-osteoarthropathy in Diabetes: A Randomized, Double-Blind, Placebo-Controlled Study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…14 It is important to have a high clinical index of suspicion for the presence of Charcot arthropathy in patients with neuropathy because radiographs may appear normal, and delays in diagnosis and treatment may increase the risks of developing severe deformities, associated ulcers and infections that may be refractory to nonoperative treatment and lead to amputation. 41 Most patients were treated in the foot clinic with total contact casting despite potential complications reported previously. 17 Total contact casting is reliable and effective in the treatment of Charcot arthropathy.…”

Section: E517mentioning

confidence: 99%

Charcot arthropathy outcomes after early referral to a regional tertiary care foot clinic

Huynh,

Pilkey,

Trepman

et al. 2023

cjs

View full text Add to dashboard Cite

Charcot arthropathy outcomes after early referral to a regional tertiary care foot clinic Background: Community physicians may not encounter Charcot arthropathy frequently, and its symptoms and signs may be nonspecific. Patients often have a delay of several months before receiving a formal diagnosis and referral for specialty care. However, limited Canadian data are available. We evaluated the clinical history, treatment and outcomes of patients treated for Charcot arthropathy after prompt referral and diagnosis. Methods:We performed a retrospective chart review of 76 patients with diabetes (78 feet) who received nonoperative treatment for Charcot arthropathy in a specialty foot clinic between Jan. 20, 2009, and Mar. 26, 2018. Patients were referred to the foot clinic by community physicians for evaluation or were pre-existing patients at the foot clinic with new-onset Charcot arthropathy.Results: Of the 78 feet included in our analyses, 52 feet (67%) were evaluated initially by a community physician and referred to the foot clinic, where they were seen within 3 ± 5 weeks. The remaining 26 feet (33%) were already being treated at the foot clinic. Most feet had swelling, erythema, warmth, a palpable pulse and loss of protective sensation. Ulcers were present initially in 23 feet (29%). Sixty-four feet (82%) with Charcot arthropathy were in Eichenholtz classification stage 1 and most had midfoot involvement. Nonoperative treatment included total contact casting (60 feet, 77%). Mean duration of nonoperative treatment until resolution for 55 feet (71%) was 6 ± 5 months. Surgery was performed on 20 feet (26%) for the treatment of infection and recurrent ulcer associated with deformity, including 6 (8%) lower limb amputations. Conclusion:Charcot arthropathy may resolve in most feet with early referral and nonoperative treatment, but remains a limb-threatening condition. Contexte :Les médecins en milieu communautaire risquent peu de voir des cas d'arthropathie de Charcot, dont les signes et symptômes sont parfois non spécifiques. Souvent, les malades attendant des mois avant d'obtenir un diagnostic formel et d'être mis en contact avec des spécialistes. Toutefois, on dispose de peu de données canadiennes. Nous avons voulu explorer l'évolution clinique, le traitement et l'issue de la maladie chez les malades traités pour l'arthropathie de Charcot après une consultation et un diagnostics rapides.Méthodes : Nous avons procédé à une revue rétrospective des dossiers de 76 personnes diabétiques (78 pieds) ayant bénéficié d'un traitement non chirurgical pour l'arthropathie de Charcot dans une clinique du pied entre le 20 janvier 2009 et le 26 mars 2018. Ce sont les médecins en milieu communautaire qui avaient adressé leurs malades à la clinique du pied pour évaluation ou alors, il s'agissait de patients déjà suivis à la clinique du pied qui présentaient une arthropathie de Charcot de novo.Résultats : Parmi les 78 pieds inclus dans nos analyses, 52 (67 %) ont d'abord été examinés par un médecin en milieu communautaire, puis on...

show abstract

“…Yet, the socioeconomic impact of the disease continues to be a tremendous cost to our healthcare system with minimal change in morbidity or mortality. 1,2 As the rate of diabetic neuropathy increases, so will CN. A greater effort must be placed on understanding this disease and formulating treatment guidelines.…”

Section: Introductionmentioning

confidence: 99%

Charcot Neuroarthropathy: Current Concepts

Martinazzi,

Manto,

Dopke

et al. 2024

SurgiColl

View full text Add to dashboard Cite

In orthopaedics, there are exceptionally few disease entities that are as poorly understood and devoid of evidence-based guidelines as there are with Charcot Neuroarthropathy (CN) of the lower extremity. CN is associated with high morbidity and mortality rates, with its financial impact on the healthcare system being substantial. The disease is likely due to the combination of the previously described neurovascular and neurotraumatic theories. Thus, physicians should highly suspect CN in any diabetic patient with ulcers or apparent deformities. The recognition and further classification of CN can then help guide further management, which includes both nonoperative and operative approaches. The optimal timing for surgical intervention remains unknown; however, some authors have successfully operated during the acute phase of the disease. Caring for the Charcot patient requires a multidisciplinary approach, including infectious disease specialists, endocrinologists, wound care teams, social workers, and surgeons. As there are no current widely accepted evidence-based guidelines or algorithms used to manage patients, our topical review provides a framework for understanding, diagnosing, staging, and managing a patient with CN in addition to the author’s preferred treatment method and our approach to a patient diagnosed with CN.

show abstract

Excess Cost and Healthcare Resources Associated With Delayed Diagnosis of Charcot Foot

Cited by 13 publications

References 16 publications

Effect of Recombinant Human Parathyroid Hormone (1-84) on Resolution of Active Charcot Neuro-osteoarthropathy in Diabetes: A Randomized, Double-Blind, Placebo-Controlled Study

Effect of Recombinant Human Parathyroid Hormone (1-84) on Resolution of Active Charcot Neuro-osteoarthropathy in Diabetes: A Randomized, Double-Blind, Placebo-Controlled Study

Charcot arthropathy outcomes after early referral to a regional tertiary care foot clinic

Charcot Neuroarthropathy: Current Concepts

Contact Info

Product

Resources

About