A limited surgical intervention program displayed efficacy in 340
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
radiograph of a representative foot with Charcot arthropathy in the study
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
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
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
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
- 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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