Long-term follow-up of conservative treatment of Charcot feet

Abstract

Background Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially being treated conservatively, and to identify risk factors for reactivation and contralateral development of CN as well as common complications in CN. Methods A total of 184 Charcot feet in 159 patients (median age 60.0 (interquartile range (IQR) 15.5) years, 49 (30.1%) women) were retrospectively analyzed by patient chart review. Rates of limb salvage, reactivation, contralateral development and common complications were recorded. Statistical analysis was performed to identify possible risk factors for limb loss, CN reactivation, contralateral CN development, and ulcer development. Results Major amputation-free survival could be achieved in 92.9% feet after a median follow-up of 5.2 (IQR 4.25, range 2.2–11.25) years. CN recurrence occurred in 13.6%. 32.1% had bilateral CN involvement. Ulcers were present in 72.3%. 88.1% patients were ambulating in orthopaedic footwear without any further aids. Presence of Diabetes mellitus was associated with reactivation of CN, major amputation and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations. Conclusions With consistent conservative treatment of CN with orthopaedic footwear or orthoses, limb preservation can be achieved in 92.9% after a median follow-up of 5.2 years. Patients with diabetic CN are at an increased risk of developing complications and CN reactivation. To prevent ulcers and amputations, every effort should be made to make patients stop smoking. Level of Evidence III, long-term retrospective cohort study

Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy

“…Even the optimal treatment strategy for Charcot foot deformity without infection is a much-debated topic. This foot complication has been reported to be associated with a rate of limb loss of 7% within 5 years ( Gratwohl et al, 2021 ). When Charcot foot is complicated by osteomyelitis, most surgeons have traditionally opted for a complete resection of the infected bone, with a later procedure to correct the deformity after (presumed) resolution of osteomyelitis ( Donegan et al, 2013 ).…”

“…The major factors leading to DFO are long-standing peripheral neuropathy and foot ulcers, with or without co-existent angiopathy. In contrast, CN is relatively rare, with an incidence in people with diabetes of 0.1-0.3%, but it too can be limb threatening ( Fabrin et al, 20 0 0 ;Gratwohl et al, 2021 ;Rajbhandari et al, 2002 ;Stuck et al, 2008 ). CN virtually always occurs in patients with peripheral neuropathy, but usually in the absence of severe peripheral arterial disease ( Boulton and Whitehouse, 20 0 0 ).…”

No Difference in Risk of Amputation or Frequency of Surgical Interventions Between Patients With Diabetic and Nondiabetic Charcot Arthropathy

“…Charcot neuro-osteoarthropathy (CN) of the foot and ankle may lead to bone and joint destruction, foot collapse, and even complications in the contralateral foot [11,28,32]. In approximately 75% of patients with CN, diabetes is the cause of underlying neuropathy [17,27,28]. In addition to numerous idiopathic sensorimotor neuropathies, further causes of this condition include vitamin B12 deficiency, spinal diseases or injuries, toxic agents (such as alcohol or medication misuse), infections, exposure to heavy metals, and inflammatory diseases [2,10,16,17,19,21,23].…”

“…In approximately 75% of patients with CN, diabetes is the cause of underlying neuropathy [17,27,28]. In addition to numerous idiopathic sensorimotor neuropathies, further causes of this condition include vitamin B12 deficiency, spinal diseases or injuries, toxic agents (such as alcohol or medication misuse), infections, exposure to heavy metals, and inflammatory diseases [2,10,16,17,19,21,23]. Despite extensive nonsurgical treatment and even the use of complex surgical reconstruction procedures, limb loss occurs in up to 15% of patients [17].…”

Pedobarographic evaluation of five commonly used orthoses for the lower extremity

“…General functions include immobilization, protected range of motion, selective load reduction, or the correction of the shape and function of the body. Thereby, they allow for earlier mobilization, pain reduction, and secure nonoperative or operative treatment [1][2][3].…”