Current practice patterns in the treatment of Charcot foot.
Treatment of Charcot foot osteoarthropathy has emerged as a major component of the American Orthopaedic Foot and Ankle Society (AOFAS) Diabetes 2000 Initiative. A two-part survey described treatment patterns and current footwear use of patients with Charcot osteoarthropathy of the foot and ankle. In the first part, 94 consecutive patients with a history of Charcot foot and ankle presenting for care were questioned on their foot-specific treatment and current footwear use. A history of diabetic foot ulcer was given by 39 (41%) patients, and an infection had been present in a foot of 20 (21%) patients. The initial treatment of the Charcot foot and ankle had been a total contact cast in 46 (49%) patients, and a pre-fabricated walking boot in 19 (20%). Charcot related surgery had consisted of 76 procedures in 46 (49%) patients. Sixty-three (67%) patients were currently using accommodative footwear (depth-inlay shoes in 46 [49%], custom shoes in 10 [11%], and CROW in 7 [7%] patients), and 72 (77%) were currently using custom accommodative foot orthoses. The second part of this study consisted of a questionnaire completed by 37 orthopaedic surgeons (members of AOFAS) interested in forming a Charcot Study Group. They treated an average of 11.8 patients having Charcot foot or ankle per month. Thirty (81%) used the Semmes-Weinstein 5.07 monofilament as a screening tool for peripheral neuropathy. For treatment of Eichenholtz Stage I, 29 (78%) used a total contact cast and 15 (41%) allowed weightbearing; for Stage II, 30 (81%) physicians used a total contact cast and 18 (49%) allowed weightbearing. Although the literature contains uniform recommendations for immobilization and non-weightbearing as treatment for the initial phases of Charcot arthropathy, the results of this benchmarking study reveal that currenl treatment is varied.
Pinzur
M S
MS
Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, IL 60153, USA. mpinzu1@luc.edu
Shields
N
N
Trepman
E
E
Dawson
P
P
Evans
A
A
D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019985:Benchmarking; D003625:Data Collection; D048909:Diabetes Complications; D005531:Foot Deformities, Acquired / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D008875:Middle Aged; D009985:Orthopedics / Q000592:standards* / Q000706:statistics & numerical data; D009989:Orthotic Devices; D013640:Tarsal Joints