Conservative treatment can be efficacious in treatment of Charcot arthropathy

A limited surgical intervention program displayed efficacy in 340 patients with Charcot arthropathy of the foot and ankle, according to a recently presented study.

The findings were presented by Alexander Rabinovich, MD, at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society in National Harbor, Md.

Rabinovich noted that there is little in terms of consensus when it comes to indications for surgical and nonsurgical management of Charcot arthropathy, with a wide range of treatments being described but relatively little data on the natural history and long-term outcomes of treatments.

“The purpose of the study was to examine the natural history of Charcot arthropathy in the foot and ankle, in addition to evaluating the correlation with anatomic classification,” Rabinovich said. “We looked at the demographics, the comorbidity, the anatomic classification, the surgery, ambulatory function and work status.”

Rabinovich’s team performed a retrospective clinical and radiographic review of 340 patients with Charcot arthropathy of the foot and ankle.

Weight-bearing radiograph of a representative foot with Charcot arthropathy in the study population
Weight-bearing radiograph of a representative foot with Charcot arthropathy in the study population
Weight-bearing radiograph of a representative foot with Charcot arthropathy in the study population.

Image: Rabinovich A

Study methods and findings

With an average clinical and radiographic follow-up duration of 4.1 years, the researchers noted that type 1 diabetes was reported in 46.5% of patients. Type 2 diabetes was reported in 34.4% of patients, with 19.1% found to not have diabetes. Brodsky Classifications of each patient consisted of 54.0% with Midfoot Type 1, 28.2% with Hindfoot Type 2, 14.7% with Ankle Type 3A, 0.5% with Calcaneus Type 3B, and 2.6% with forefoot involvement. Furthermore, bilateral involvement was seen in 33.2% of patients.

Rabinovich reported that the mean number of surgeries per patient was 1.21, but 159 required no surgical intervention.

“Forty-six percent did not require any surgery whatsoever,” he said.

Seventy-one percent of patients with unilateral or bilateral involvement were reported by Rabinovich to require one surgery or less.

The most frequent surgical procedures reported in the study were ulcer debridement and ostectomy, which made up 95% of cases. There were equal rates in unilateral and bilateral cases. Partial foot and below-knee amputations, Rabinovich said, consisted of less than 5.0% of all surgeries.

The results of treatment were positive, with 331 (97.4%) patients displaying ambulatory ability at their last visit and 109 (32.0%) reporting employment.

Conservative efficacy

The study was noted as being one of the longest follow-ups in one of the largest series of Charcot arthropathy of the foot and ankle to have been presented.

The findings pointed toward a greater association of Charcot arthropathy in patients with type 1 diabetes, made apparent by a disproportionately increased population of patients with type 1 diabetes in the patient population as opposed to the general population of people with diabetes. Furthermore, a high level of bilateral involvement was demonstrated suggesting increased scrutiny for contralateral involvement in Charcot arthropathy patients.

Perhaps the most important finding, however, was that of the efficacy of conservative treatment. Almost half of the patients in the study reportedly required no surgical therapy, and were successfully treated with total contact casting, braces, custom shoe wear, and insoles.

“Excellent outcomes with a predominately conservative treatment of Charcot can be achieved,” Rabinovich said. – by Robert Press

Reference:
  • Rabinovich A, Brodsky JW. Intermediate-term follow-up and outcomes of 340 patients with charcot arthropathy of the foot and ankle. Presented at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 7-10. National Harbor, Md.

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A limited surgical intervention program displayed efficacy in 340 patients with Charcot arthropathy of the foot and ankle, according to a recently presented study.

The findings were presented by Alexander Rabinovich, MD, at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society in National Harbor, Md.

Rabinovich noted that there is little in terms of consensus when it comes to indications for surgical and nonsurgical management of Charcot arthropathy, with a wide range of treatments being described but relatively little data on the natural history and long-term outcomes of treatments.

“The purpose of the study was to examine the natural history of Charcot arthropathy in the foot and ankle, in addition to evaluating the correlation with anatomic classification,” Rabinovich said. “We looked at the demographics, the comorbidity, the anatomic classification, the surgery, ambulatory function and work status.”

Rabinovich’s team performed a retrospective clinical and radiographic review of 340 patients with Charcot arthropathy of the foot and ankle.

Weight-bearing radiograph of a representative foot with Charcot arthropathy in the study population
Weight-bearing radiograph of a representative foot with Charcot arthropathy in the study population
Weight-bearing radiograph of a representative foot with Charcot arthropathy in the study population.

Image: Rabinovich A

Study methods and findings

With an average clinical and radiographic follow-up duration of 4.1 years, the researchers noted that type 1 diabetes was reported in 46.5% of patients. Type 2 diabetes was reported in 34.4% of patients, with 19.1% found to not have diabetes. Brodsky Classifications of each patient consisted of 54.0% with Midfoot Type 1, 28.2% with Hindfoot Type 2, 14.7% with Ankle Type 3A, 0.5% with Calcaneus Type 3B, and 2.6% with forefoot involvement. Furthermore, bilateral involvement was seen in 33.2% of patients.

Rabinovich reported that the mean number of surgeries per patient was 1.21, but 159 required no surgical intervention.

“Forty-six percent did not require any surgery whatsoever,” he said.

Seventy-one percent of patients with unilateral or bilateral involvement were reported by Rabinovich to require one surgery or less.

The most frequent surgical procedures reported in the study were ulcer debridement and ostectomy, which made up 95% of cases. There were equal rates in unilateral and bilateral cases. Partial foot and below-knee amputations, Rabinovich said, consisted of less than 5.0% of all surgeries.

The results of treatment were positive, with 331 (97.4%) patients displaying ambulatory ability at their last visit and 109 (32.0%) reporting employment.

Conservative efficacy

The study was noted as being one of the longest follow-ups in one of the largest series of Charcot arthropathy of the foot and ankle to have been presented.

The findings pointed toward a greater association of Charcot arthropathy in patients with type 1 diabetes, made apparent by a disproportionately increased population of patients with type 1 diabetes in the patient population as opposed to the general population of people with diabetes. Furthermore, a high level of bilateral involvement was demonstrated suggesting increased scrutiny for contralateral involvement in Charcot arthropathy patients.

Perhaps the most important finding, however, was that of the efficacy of conservative treatment. Almost half of the patients in the study reportedly required no surgical therapy, and were successfully treated with total contact casting, braces, custom shoe wear, and insoles.

“Excellent outcomes with a predominately conservative treatment of Charcot can be achieved,” Rabinovich said. – by Robert Press

Reference:
  • Rabinovich A, Brodsky JW. Intermediate-term follow-up and outcomes of 340 patients with charcot arthropathy of the foot and ankle. Presented at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 7-10. National Harbor, Md.

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