The Diagnosis of Charcot Foot

Rogers, Lee C.; Bevilacqua, Nicholas J.

doi:10.1016/j.cpm.2007.10.006

Cited by 39 publications

(33 citation statements)

References 11 publications

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“…No previous studies dealing with antibiotic treatment of DFO confirmed osteomyelitis by means of histopathological study of bone samples. This is a limitation of our study because some patients may had have radiological changes as a result of neuroarthropathy rather than a bone infection (24).…”

Section: Discussionmentioning

confidence: 95%

Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial

2014

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OBJECTIVE No prospective trials have been carried out comparing antibiotic treatment alone with primarily surgical treatment in patients with diabetes and foot osteomyelitis. The aim of the current study was to compare the outcomes of the treatment of diabetic foot osteomyelitis in patients treated exclusively with antibiotics versus patients who underwent conservative surgery, following up the patients for a period of 12 weeks after healing. RESEARCH DESIGN AND METHODS Between 1 January 2010 and 31 December 2012, a prospective randomized comparative trial (clinical trial reg. no. NCT01137903, clinicaltrials.gov) of patients with diabetes who had received a diagnosis of neuropathic foot ulcers complicated by osteomyelitis was carried out at the Diabetic Foot Unit at the Complutense University of Madrid. Patients were randomized into the following two groups: the antibiotics group (AG) and the surgical group (SG). Antibiotics were given for a period of 90 days in the AG. Patients in the SG received conservative surgery with postoperative antibiotic treatment for 10 days. RESULTS Eighteen patients (75%) achieved primary healing in the AG, and 19 (86.3%) in the SG (P = 0.33). The median time to healing was 7 weeks (quartile [Q] 1 to Q5, Q3–Q8) in the AG and 6 weeks (Q1–Q3, Q3–Q9) in the SG (P = 0.72). The conditions of four patients from the AG worsened (16.6%), and they underwent surgery. Three patients from the SG required reoperation. No difference was found between the two groups regarding minor amputations (P = 0.336). CONCLUSIONS Antibiotic therapy and surgical treatment had similar outcomes in terms of healing rates, time to healing, and short-term complications in patients with neuropathic forefoot ulcers complicated by osteomyelitis without ischemia or necrotizing soft tissue infections.

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Section: Discussionmentioning

confidence: 95%

Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial

2014

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“…The diagnosis of acute CN is primarily dependant on this initial clinical presentation and therefore requires high clinical suspicion by the treating clinician for all patients with diabetes and peripheral neuropathy who present with these clinical signs and symptoms [14]. More advanced presentations of acute CN may also present with obvious foot deformity, including the characteristic ‘rocker-bottom’ deformity that is emblematic of CN [16]. …”

Section: Resultsmentioning

confidence: 99%

Developing an evidence‐based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro‐Arthropathy: a systematic review

Milne

Rogers

Kinnear

et al. 2013

Journal of Foot and Ankle Research

153

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BackgroundCharcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors’ knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes.MethodsElectronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway.ResultsThe systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN.ConclusionsThis research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations.

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“…Rogers and Bevilacqua describe an amputation classification risk scheme illustrating how as Charcot deformity, ulceration and osteomyelitis approach the proximal foot and ankle, amputation risk increases [24] (Table 4). …”

Section: Amputation Riskmentioning

confidence: 99%

“…A combined anatomic and complexity classification of Charcot neuroarthropathyAdapted from Rogers and Belivqua [60]. Using both an anatomic model combined with level of complexity, it is clearly demonstrated that as one progresses both proximal (to the right on the graph) in anatomic location and/or toward osseous involvement (down on the graph), the risk of major amputation increases…”

Section: Amputation Riskmentioning

confidence: 99%

Charcot stage 0: A review and consideratons for making the correct diagnosis early

Holmes

Schmidt

Munson

et al. 2015

Clin Diabetes Endocrinol

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Charcot neuropathic osteoarthropathy (CN) is a rare disease (NIDDK, NIH Summary Report Charcot Workshop, 2008) that causes significant morbidity and mortality for affected patients. The disease can result in severe deformities of the foot and ankle that contribute to the development of ulcerations and amputations. Medical advances have failed to find ways to stop the progression of the disease. However, it is known that early detection of the CN has a substantial impact on patient outcomes. CN in the earliest stage is very difficult to recognize and differentiate from other similar presenting diseases. We intend to outline clinical considerations practitioners can use when evaluating a patient with early stage suspected CN.

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The Diagnosis of Charcot Foot

Cited by 39 publications

References 11 publications

Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial

Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial

Developing an evidence‐based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro‐Arthropathy: a systematic review

Charcot stage 0: A review and consideratons for making the correct diagnosis early

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