The acute diabetic Charcot foot managed on the basis of magnetic resonance imaging – a review of 71 cases

Chantelau, Ernst; Richter, Andreas

doi:10.4414/smw.2013.13831

Cited by 47 publications

(95 citation statements)

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“…Grade 0 cases, which may heal by direct (primary) fracture healing [30], seemed to require shorter TCC treatment (approximately 25 weeks [28]) until ‘healing’ than grade 1 cases (approximately 35 weeks), which invariably heal by indirect (secondary) fracture healing [30]. In a previous retrospective study based on clinical and x-ray monitoring [25], we found a non-significant difference in average ‘healing’ time of 1 month between grade 0 and 1. Disappearance of EESC seems to require longer treatment than ‘healing’ defined by clinical and plain x-ray criteria [23].…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…MRI follow up in most cases was stopped before complete disappearance of EESC. The decision to cease TCC treatment was based on clinical judgment aided by MRI and/or x-ray follow-up findings [25]. …”

Section: Methodsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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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“…Advanced imaging modalities, such as MRI and bone scans, are of use in such instances, leading to earlier diagnosis, staging, and intervention [3]. MRI is considered the most sensitive modality in the detection of early changes of Charcot neuropathy, and will delineate soft tissue edema, arch collapse, joint effusions, and subchondral bone marrow edema of involved joints [24].…”

Section: Limitationsmentioning

confidence: 99%

Classifications in Brief: Eichenholtz Classification of Charcot Arthropathy

Rosenbaum

DiPreta

2015

Clinical Orthopaedics &Amp; Related Research

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“…Обсервационные исследования, прове-денные в этой области, также показали, что разгрузка и иммобилизация конечности на рентген-негативном этапе в течение 6-15 мес позволяют подавить актив ность воспа-лительного процесса, добиться клиническо-го выздоровления и предотвратить развитие выраженных деформаций [5][6][7][8]. В то же время отсутствие лечения на рентген-нега-тивной стадии неизбежно приводит к пере-ломам и деструктивной артропатии [6,[9][10][11].…”

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Diabetic neuroosteoarthropathy: the modern approaches for diagnosis and immobilization period determination (review)

Kaminarskaya¹

2015

Endo Serg

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Диабетическая нейроостеоартропатия (ДНОАП) является редким, но тяжелым ос-ложнением диабетической полинейропатии. Это состояние, характеризующееся про-грессирующей деструкцией костей и суста-вов стопы, неизбежно приводит к выражен-ной деформации стоп. Причины развития ДНОАП не до конца ясны. Существуют убеди-тельные доказательства, что провоцирую-щим фактором ДНОАП является нераспоз-нанная травма, инфицированная язва или оперативное вмешательство на стопе. Распространенность ДНОАП среди пациен-тов с сахарным диабетом (СД), по данным разных авторов, составляет от 0,08 до 7,5%. (В некоторых работах были зафиксированы более высокие показатели распространен-ности ДНОАП: у 13% среди всех больных СД и у 29% пациентов с диабетической поли-нейропатией [1, 2]; однако эти цифры вызы-вают ряд вопросов, в том числе касающихся критериев постановки диагноза и формиро-вания выборки.)ДНОАП ассоциирована с высокой часто-той ампутаций и уровнем смертности. Согласно исследованию Pakarinen T.-K. и соавт., в котором был отслежен 41 пациент с острой ДНОАП, общая смертность соста- Endocrinology Research Centre, Moscow, Russian FederationДиабетическая нейроостеоартропатия -осложнение сахарного диабета, ассоциированное с высокой частотой ампутаций и уровнем смертности. Благодаря развитию методов диагностики сегодня стало возможным выявление диабетической нейроостеоартропатии на ранней рентген-негативной стадии. Лечение на данном этапе способно предотвратить развитие выраженной деструкции костного скелета стопы и формирование серьезных деформаций. Однако не существует единого подхода к диагностике рентген-негативной стадии диабетической нейро остео-артропатии. Также остается спорным вопрос о сроках иммобилизации пораженной конечности и методах определения завершения острой стадии диабетической нейроостеоартропатии. Данный обзор посвящен современному состоянию знаний о диагностике, классификации и критериях завершения активной стадии диабетической нейроостеоартропатии. Клю че вые сло ва: сахарный диабет, стопа Шарко, ранняя диагностика, МРТ.Diabetic neuroosteoarthropathy is complication of diabetes associated with high rates of amputations and mortality. The development of diagnostic methods may identify diabetic neuroosteoarthropathy at early X-ray negative stage before the development of radiographic changes. Treatment at this stage can prevent the development of progressive bone and joint deterioration. However, there is no unified approach to diagnose of X-ray negative stage. The timing of immobilization of the affected limb is still controversial among experts, and where is no objective methods for determining the completion of the acute stage of diabetic neuroosteoarthropathy. This review focuses on the current state of knowledge about the diagnosis, classification and criteria for completion of the active phase of diabetic neuroosteoarthropathy.

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The acute diabetic Charcot foot managed on the basis of magnetic resonance imaging – a review of 71 cases

Abstract: Healing of ACF was more efficient in stage 0 than in stage 1. Expeditious MR imaging was indispensable to diagnose stage 0 in a swollen foot of a neuropathic patient, while unremarkable X-rays often led to a missed diagnosis.

Cited by 47 publications

References 47 publications

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

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

Classifications in Brief: Eichenholtz Classification of Charcot Arthropathy

Diabetic neuroosteoarthropathy: the modern approaches for diagnosis and immobilization period determination (review)

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