Introduction: Loss of protective sensation, inflammation and trauma may lead in predisposed diabetics with peripheral neuropathy to Charcot foot.
Methods: Regular foot screening enables identification of those individuals who are at highest risk for foot ulceration. Special attention must be paid to infection. Differentiation between osteomyelitis and Charcot arthropathy is mandatory, the two conditions may coexist. Basic conservative treatment for Charcot arthropathy is offloading with bed rest or total contact cast with healing shoe. The active acute form should be detected promptly in order to apply bisphosphonate or calcitonin therapy which may improve healing and stabilisation of the disease and postpone deformities. Few data on this treatment are available. In our clinic we keep an electronic diabetic foot patient record since 2009. Among 6000 diabetics, 185 have electronic record, 89 an active foot ulcer. Seven with Charcot arthropathy were detected, all having peripheral neuropathy, one due to alcohol, two women and five men. One patient died in 2009. One has chronic bilateral form of the disease, other presented with an acute form. All have been referred to orthopaedic surgeon with a native X-ray, one with scintigram, one MRI was done. All were complicated with infection and healed in 824 months. One had transmetatarsal amputation. Two have ischemia, others mediocalcinosis. In the observational period no one received drug treatment, one received bisphosphonates in 2006 when the disease was active on his left foot.
Results and conclusions: We conclude that in this short period the incidence of the acute form of Charcot arthropaty was higher. The acute active form of Charcot arthropathy can be found if it is searched for. Early detection of patients with acute Charcot foot and appropriate treatment are cornerstones of foot ulcer and deformity prevention.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
05 - 09 May 2012
European Society of Endocrinology