Bone mineral density during total contact cast immobilization for a patient with neuropathic (Charcot) arthropathy.
OBJECTIVE
Diabetes mellitus (DM)-related neuropathic arthropathy of the foot is a destructive bone and joint process. The effect of cast immobilization and non-weight bearing on bone loss has not been well studied. The purpose of this case report is to describe the changes in bone mineral density (BMD) of the calcaneus in the feet of a patient with acute neuropathic arthropathy during total contact cast immobilization.


METHODS
The patient was a 34-year-old woman with type 1 DM, renal failure requiring dialysis, and a 7-week duration of neuropathic arthropathy of the midfoot. Intervention included total contact casting and minimal to no weight bearing for 10 weeks, with transition to therapeutic footwear. Ultrasound-derived estimates of BMD were taken of both involved and uninvolved calcanei.


RESULTS
Bone mineral density decreased for the involved foot (from 0.25 g/cm(2) to 0.20 g/cm(2)) and increased for the uninvolved foot (from 0.27 g/cm(2) to 0.31 g/cm(2)) during casting.


CONCLUSIONS
The low initial BMD and further loss during casting suggest the need for transitional bracing and a well-monitored return to full activity to minimize the risk of recurrence and progression of foot deformity.
Hastings
Mary K
MK
Program in Physical Therapy, School of Medicine, Washington University, St Louis, MO 63110, USA. hastingsm@msnotes.wustl.edu
Sinacore
David R
DR
Fielder
Faye A
FA
Johnson
Jeffrey E
JE
D000328:Adult; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000534:rehabilitation*; D015519:Bone Density / Q000502:physiology*; D001915:Braces; D002111:Calcaneus / Q000293:injuries / Q000503:physiopathology; D002370:Casts, Surgical / Q000009:adverse effects; D017719:Diabetic Foot / Q000150:complications*; D005260:Female; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D007103:Immobilization / Q000009:adverse effects / Q000379:methods; D010024:Osteoporosis / Q000209:etiology; D011383:Progressive Patient Care; D011859:Radiography; D012881:Skin Temperature / Q000502:physiology; D016896:Treatment Outcome; D014861:Washington
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