title: Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases.
abstract: OBJECTIVE
  The incidence of diabetic Charcot neuroarthropathy has increased. The purpose here was to study the current diagnostics and treatment of the Charcot foot.
  
  
  METHODS
  During a time period from 1994 to 2000, a total of 36 feet were diagnosed as cases of diabetic Charcot neuroarthropathies. A retrospective analysis of patient records and radiographs was undertaken. A review of the recent literature is presented.
  
  
  RESULTS
  29 cases were diagnosed in the dissolution stage, 2 in coalascence, and 5 in the resolution stage. The diagnostic delay averaged 29 weeks. Treatment with cast immobilisation ranged from 4 to 37 weeks (mean 11 weeks). A total of 14 surgical procedures were carried out on 10 patients: six exostectomies, four midfoot arthrodeses, one triple arthrodesis, one tibiocalcaneal arthrodesis and two below-knee amputations. A radiological fusion was achieved in two thirds of the attempted arthrodeses.
  
  
  CONCLUSIONS
  A physician should always consider the Charcot neuroarthropathy when a diabetic patient has an inflamed foot. In the absence of fever, elevated CRP or ESR, infection is a highly unlikely diagnosis, and a Charcot process should primarily be considered. The initial treatment of an inflamed Charcot foot consists in sufficiently long non-weightbearing with a cast, which should start immediately after the diagnosis. The prerequisites of successful reconstructive surgery are correct timing, adequate fixation and a long postoperative non-weightbearing period. In the resolution stage most Charcot foot patients need custom-molded footwear.
authors.affiliation: Medical School, University of Tampere, Finland.
authors.forename: T K
authors.initials: TK
authors.lastname: Pakarinen
authors.forename: H J
authors.initials: HJ
authors.lastname: Laine
authors.forename: S E
authors.initials: SE
authors.lastname: Honkonen
authors.forename: J
authors.initials: J
authors.lastname: Peltonen
authors.forename: H
authors.initials: H
authors.lastname: Oksala
authors.forename: J
authors.initials: J
authors.lastname: Lahtela
mesh_terms: D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D002370:Casts, Surgical; D016009:Chi-Square Distribution; D017719:Diabetic Foot / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome