The Natural History of Acute Charcot’s Arthropathy in a Diabetic Foot Specialty Clinic

Armstrong, David G.; Todd, William F.; Lavery, Larry A.; Harkless, Lawrence B.; Bushman, Tod R.

doi:10.1002/(sici)1096-9136(199705)14:5<357::aid-dia341>3.0.co;2-8

Cited by 245 publications

(64 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our average duration of treatment corresponds to the findings of Armstrong et al with a period of 18.5 ± 10.6 weeks and Christensen et al of 20.1 ± 3 weeks [27]. However, they reported a re-casting of the unprotected extremity for a mean of 11.2 weeks in cases of exacerbation or recurrence of CN after reloading, i.e., upon initial cast removal [27, 44]. Bates et al treated 34 patients with a TCC and 12 individuals with a removable cast walker in the presence of contraindications for a TCC for 11 (range: 8 to16.7) months, and 33% had to extend their treatment period to a total duration of 20 (range, 15 to 21) (Bates M, Petrova NL, Edmonds ME: How long does it take to progress from cast to shoes in the management of Charcot osteoarthropathy?…”

Section: Discussionsupporting

confidence: 84%

See 1 more Smart Citation

Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

Renner

Wirth

Osterhoff

et al. 2016

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundCharcot neuropathic arthropathy (CN) is a chronic, progressive, destructive, non-infectious process that most frequently affects the bone architecture of the foot in patients with sensory neuropathy. We evaluated the outcome of protected weightbearing treatment of CN in unilaterally and bilaterally affected patients and secondarily compared outcomes in protected versus unprotected weightbearing treatment.MethodsPatient records and radiographs from 2002 to 2012 were retrospectively analyzed. Patients with Type 1 or Type 2 diabetes with peripheral neuropathy were included. Exclusion criteria included immunosuppressive or osteoactive medication and the presence of bone tumors. Ninety patients (101 ft), mean age 60.7 ± 10.6 years at first diagnosis of CN, were identified. Protected weightbearing treatment was achieved by total contact cast or custom-made orthosis. Ulcer, infection, CN recurrence, and amputation rates were recorded. Mean follow-up was 48 (range 1–208) months.ResultsPer the Eichenholtz classification, 9 ft were prodromal, 61 in stage 1 (development), 21 in stage 2 (coalescence) and 10 in stage 3 (reconstruction). Duration of protected weightbearing was 20 ± 21 weeks and 22 ± 29 weeks in patients with unilateral and bilateral CN, respectively. In bilaterally affected patients, new ulcers developed in 9/22 (41%) feet. In unilaterally affected patients, new ulcers developed in 5/66 (8%) protected weightbearing feet and 4/13 (31%) unprotected, full weightbearing feet (p = 0.036). The ulceration rate was significantly higher in bilaterally versus unilaterally affected patients with a protected weightbearing regimen (p = 0.004). Soft tissue infection occurred in 1/13 (8%) unprotected weightbearing feet and 1/66 (2%) protected weightbearing feet in unilaterally affected patients, and in 1/22 (4%) protected weightbearing feet of bilaterally affected patients. Recurrence and amputation rates were similar across treatment modalities.ConclusionsBilateral CN results in significantly more ulcers than unilateral CN and leads to slightly higher soft tissue infections. Protected weightbearing in an orthopedic device can reduce the risk for complications in acute CN of the foot and ankle.

show abstract

Section: Discussionsupporting

confidence: 84%

“…Game et al reported a duration of treatment to resolution (mobilized in orthotic or normal shoes) of 10 months (range 2–40 months) in a multicenter, web-based observational study of 288 cases in the UK. Armstrong et al suggested a time to footwear of 7 ± 3.6 months in 55 patients with CN [44, 45]. …”

Section: Discussionmentioning

confidence: 99%

Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

Renner

Wirth

Osterhoff

et al. 2016

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Armstrong and Lavery reported the baseline infrared dermal thermometry results for 39 patients presenting with unilateral acute Charcot foot [28] After 15 min’ rest, they found an average 8.8 ± 2.3 °F higher temperature compared to the contralateral joint of interest (JOI). In a separate study, the same team reported specific mean joint differences of 7.3 °F, 8.0 °F, and 8.8 °F for the ankle Chopart, and Lisfranc’s joint respectively [28, 29]. The temperature differences were found to correlate highly with radiographic changes [28] and with markers of bone turnover [30].…”

Section: Clinical Assessmentmentioning

confidence: 99%

“…In a separate study, the same team reported specific mean joint differences of 7.3 °F, 8.0 °F, and 8.8 °F for the ankle Chopart, and Lisfranc’s joint respectively [28, 29]. The temperature differences were found to correlate highly with radiographic changes [28] and with markers of bone turnover [30]. In the diabetic foot, statically measured joint risk factors may not be associated with dynamic activity [31].…”

Section: Clinical Assessmentmentioning

confidence: 99%

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

Holmes

Schmidt

Munson

et al. 2015

Clin Diabetes Endocrinol

View full text Add to dashboard Cite

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.

show abstract

“…Two of the most common diabetic neuropathic foot impairments seen either in community clinics or diabetic foot specialty clinics are Charcot neuroarthropathy (CNA) and neuropathic plantar ulcers (NPU). [1, 2]. Both NPU and acute CNA occur in the presence of sensory and autonomic peripheral neuropathy [3,4].…”

Section: Introductionmentioning

confidence: 99%

Immobilization-induced osteolysis and recovery in neuropathic foot impairments

Sinacore

Hastings

Bohnert

et al. 2017

Bone

View full text Add to dashboard Cite

Background Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery. Objective To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33–53 weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA). Methods Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry. Results Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p < .01); BMD in NPU immobilized feet averaged 486 ± 136 mg/cm2, and CNA immobilized feet averaged 456 ± 138 mg/cm2, p >0.05). After immobilization, index NPU feet lost 27 mg/cm2; CNA feet lost 47 mg/cm2 of BMD, p < 0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic. Conclusions There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.

show abstract

The Natural History of Acute Charcot’s Arthropathy in a Diabetic Foot Specialty Clinic

Cited by 245 publications

References 0 publications

Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

Outcome after protected full weightbearing treatment in an orthopedic device in diabetic neuropathic arthropathy (Charcot arthropathy): a comparison of unilaterally and bilaterally affected patients

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

Immobilization-induced osteolysis and recovery in neuropathic foot impairments

Contact Info

Product

Resources

About