Recognition and management of acute neuropathic (Charcot) arthropathies of the foot and ankle.
METHODS
Review of selected literature describing the outcomes related to the management of acute Charcot foot arthropathies in patients with diabetes mellitus.


OBJECTIVE
To familiarize the rehabilitation specialist with the general principles of nonsurgical management for patients with acute neuropathic arthropathies of the foot and ankle.


BACKGROUND
Neuropathic (Charcot) arthropathy of the foot or ankle is the most destructive and disabling chronic complication of all diabetic foot disease.


METHODS
We discuss the clinical presentation and the role that orthopaedic and sports physical therapists may have in identifying and preventing complications and the long-term disability associated with these arthropathies. We summarize the outcomes of 15 published reports from 1985-1999 located using the MEDLINE database from 1966-present. Studies were selected and included if the authors reported on (1) 2 or more patients with diabetes mellitus and acute Charcot arthropathies; (2) the short-term or long-term outcomes, including the length of follow-up; and (3) the pattern or location of the arthropathy. The short-term outcomes (percentage of patients healed, average time to healing) and long-term outcomes (percentage in whom treatment failed, amputation, disability) after treatment by immobilization alone or immobilization after surgery were reviewed and summarized.


RESULTS
The prognosis for an individual with severe neuropathic skeletal foot deformities is poor. Eleven deaths (3.65%) in 301 patients were reported within the average follow-up period of 2.5 years after treatment for Charcot arthropathy. Partial or complete foot amputation occurred in 20 (6.6%) of 301, whereas 83 (28%) of 301 patients reviewed had mobility limitations or required ankle-foot orthoses or permanent bracing or assistive devices for ambulation at the time of follow-up.


CONCLUSIONS
Rehabilitation specialists can improve the short-term outcomes and limit the long-term disabilities in patients with diabetes mellitus and peripheral neuropathy. Early recognition and prompt immobilization are the basic principles of nonsurgical management that influence therapeutic outcome.
Sinacore
D R
DR
Department of Medicine, Washington University School of Medicine, St Louis, Mo. 63110, USA. sinacore@medicine.wustl.edu
Withrington
N C
NC
D000671:Amputation, Surgical; D001177:Arthropathy, Neurogenic / Q000175:diagnosis* / Q000534:rehabilitation / Q000601:surgery*; D017719:Diabetic Foot / Q000150:complications*; D006801:Humans; D007103:Immobilization; D009026:Mortality; D009989:Orthotic Devices; D011379:Prognosis; D011788:Quality of Life; D016896:Treatment Outcome; D014945:Wound Healing