Response of Charcot's arthropathy to contact casting: assessment by quantitative techniques

Abstract

The assessment and management of Charcot's arthropathy has been limited by the lack of sensitive and objective assessment methods with clinical observation and radiography forming the mainstays of evaluation [1±7]. As a result, although rest and contact casting are accepted methods of treatment there is little objective data on their impact on the disease.Radionuclide scanning has been used to compare the affected foot of patients with or without Charcot's arthropathy [8]. We used two different methods of quantitative bone scanning to study the relationship between activity of Charcot's arthropathy and clinical variables over 12 months during which patients received standard treatment of rest and contact casting. Subjects and methodsSubjects. Patients (n = 17) with acute unilateral Charcot's arthropathy were treated with rest and application of contact cast and monitored by temperature measurement. In a subset AbstractAims/hypothesis. This study used two different methods of quantitative bone scanning to study the relation between activity of Charcot's arthropathy and clinical variables over 12 months. Methods. Skin temperature of affected and unaffected feet was measured at baseline and every 3 months for 12 months in 17 subjects. Eight subjects underwent a three-phase quantitative bone scan at baseline and 3 monthly for 12 months. Bone isotope uptake in a standard rectangular area over the foot and tibia was analysed by the bilateral scan method (the ratio of isotope uptake of affected and unaffected feet) and the unilateral scan method (the ratio of isotope uptake of affected foot and ipsilateral tibia). The affected foot was placed in a contact cast for an average of 8 months. Results. At presentation the affected foot was hotter than the unaffected foot but the temperature became progressively cooler over 12 months. Median isotope uptake in the affected foot was 2.1 % of the injected dose (interquartile range, IQR 1.9±3.0). In both scanning methods the ratio of uptake decreased after casting but at 12 months the affected foot still had more isotope uptake. There was a strong correlation between temperature difference and the ratio of uptake in the bilateral scan method (r = 0.90; p < 0.0001) but when using the unilateral scan method this relation was not significant (r = 0.1; p = 0.6). A strong relation existed between perfusion of the affected foot in the dynamic phase and isotope uptake in the delayed phase of the scans (r = 0.92; p < 0.0001). Conclusion/interpretation. Bone activity and skin temperature of Charcot's arthropathy can be measured quantitatively and both improve over 12 months with contact casting. There is a strong relation between perfusion and disease activity in this condition. [Diabetologia (2000) 43:481±484]

Bisphosphonates in the treatment of Charcot neuroarthropathy: a double-blind randomised controlled trial

“…In the present study we found that foot temperatures dropped significantly in the active and placebo groups as early as two weeks after entering into the study. The reduction in temperature in the placebo group is most likely due to the fact that all patients received off-loading measures in agreement with the observations of investigators that following total contact casting significant reduction in skin temperature was observed as well as reduction in bone isotope uptake [17]. In addition to the initial fall in temperature, we also found a further decrease in foot temperatures in the active group.…”

“…Measuring foot temperatures has been shown to be an effective means of assessing activity of the Charcot foot [6]. In a recent study of acute CNA, skin temperature was shown to correlate with bone uptake of radio-isotope and disease activity [17]. In the present study we found that foot temperatures dropped significantly in the active and placebo groups as early as two weeks after entering into the study.…”

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

“…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.…”

Pamidronate Treatment in Charcot Neuro-Osteoarthropathy: Change in Biochemical Markers of Bone Turnover and Radiographic Outcome After Treatment

“…In a short communication, Mc Gill et al reported that bone uptake scintigraphy and skin temperature improved over 12 months with immobilization (McGill et al, 2000), but there are no studies evaluating changes in neither MRI nor bone scintigraphy after bisphosphonate treatment.…”