How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet?
Diabetes mellitus and its related complications are increasing at epidemic rates in the United States. Similarly, Charcot foot and ankle deformities are becoming more prevalent. We did a retrospective review of 115 patients (127 limbs) with diabetes mellitus-associated neuroarthropathy to determine the major clinical outcomes. We hypothesized that an intensive disease-specific protocol would result in low rates of amputations. A single treatment protocol was followed for all subjects treated in a tertiary-based orthopaedic department from 1983-2003. Major outcome variables assessed included rates of below-knee amputation, long-term brace wear, reulceration, reconstructive surgeries, and bilaterality. Survivorship analyses were done during a median followup of 3.8 years. In this cohort, diabetic Charcot arthropathy treated in a structured, intensive, and nonoperative manner was associated with an approximately 2.7% annual rate of amputation, a 23% risk of requiring bracing for more than 18 months, and a 49% risk of recurrent ulceration. Limbs with open ulcers at initial presentation or chronically recurrent ulcers had increased risk for amputation. These results suggest that improved methods of care are needed for patients with diabetes who have Charcot arthropathy.


METHODS
Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
Saltzman
Charles L
CL
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Street, Iowa City, IA 52242, USA. charles-saltzman@uiowa.edu
Hagy
Mark L
ML
Zimmerman
Bridget
B
Estin
Miriam
M
Cooper
Reginald
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001915:Braces; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D017719:Diabetic Foot / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D016523:Foot Ulcer / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology