Management of the diabetic Charcot foot

Abstract

The diabetic Charcot foot is a major limb-threatening complication of long-term diabetes mellitus and neuropathy. Although first described over 100 years ago, we are still lacking definitive studies regarding its prevalence in this population, precise etiology, or most effective treatments. Trauma in the presence of peripheral sensory neuropathy and abundant arterial perfusion seem to be the primary causal factors leading to this severe foot deformity. Misdiagnosis or delayed diagnosis of osteoarthropathy allows the destructive phase of this disorder to continue with resultant further destruction of the foot architecture. The authors discuss the natural history of this entity as well as potential treatment options and recommendations. Through a better understanding of the underlying pathogenesis, Charcot arthropathy can be more effectively managed and thereby limit the development of severe deformity, ulceration, infection and limb loss.

Bone Mineral Density During Total Contact Cast Immobilization for a Patient With Neuropathic (Charcot) Arthropathy

“…[17][18][19] The coefficient of variation (CV) from 8 measurements over a 4-week period on a cadaver foot phantom was 2.2% for estimated BMD. 17 The intraclass correlation coefficient (ICC [3,1]) calculated from test-retest measurements at a 1-week interval on 20 subjects without known pathology or impairments was .97 for estimated BMD. 17 The manufacturer of the Sahara Clinical Bone Sonometer reported the average test-retest measurement difference for estimated BMD to be 0.014 g/cm 2 .…”

“…2 Although the cause of neuropathic arthropathy of the foot remains poorly understood, it may be affected by low bone mineral density (BMD) of the foot or ankle and by the presence and severity of peripheral neuropathy (autonomic and somatic). [2][3][4] An injury to the foot may initiate an unregulated and prolonged inflammatory response in patients with DM and peripheral neuropathy. A warm, swollen, and reddened foot marks the acute neuropathic arthropathy process.…”

“…11 The intervention most often prescribed to assist in healing the foot is cast immobilization without weight bearing for 12 weeks. 3,12 This intervention, although effective in resolving the acute inflammation, may result in additional bone loss through disuse. 13 The purpose of this case report is to describe serial measures of BMD of the calcaneus, skin temperature, and edema in a patient with DM, acute neuropathic arthropathy, and renal failure (which required dialysis) during cast immobilization to resolve the inflammatory phase of the arthropathy.…”

Surgical Treatment of Charcot Foot, Complicated Phlegmon

“…Распространенность данного осложнения среди больных сахарным диабетом составляет менее 1 % [2], хотя в литературе можно обнаружить информацию о различных проявлениях ДНОАП у 18-25 % лиц с длительностью диабета более 20 лет [3,4]. Такая про-тиворечивость сведений, очевидно, связана с разли-чиями в методике обследования и разными критери-ями диагностики нейроостеоартропатии.…”

Advanced wound care: from genetics to skin cell therapy

“…It is estimated that up to 15% of all foot ulcers will result in amputations (Frykberg et al, 2000). Diabetic foot ulcers are usually the consequences of diabetes associated peripheral neuropathy and vascular disease affecting both the macro-and microvasculature.…”