title: Recurrence of acute Charcot neuropathic osteoarthropathy after conservative treatment.
abstract: BACKGROUND
  Charcot neuropathic osteoarthropathy (CN) is a chronic, progressive-destructive process affecting the feet of patients with sensory neuropathy. Data on CN recurrence are underrepresented in the literature. The aim of the present study was to evaluate the rate of CN recurrence after its treatment and to find predisposing factors.
  
  
  METHODS
  Fifty-two patients (age 59 ± 11 years, 16 female) with acute CN with 57 affected feet were enrolled. Comorbidities, localization, and stage of disease at first diagnosis as well as ulcerations, need for surgery, noncompliance, and subsequent treatment (orthopedic footwear or orthotic treatment) during the course of therapy were recorded. During follow-up, the incidence of recurrence of CN was observed. Mean follow-up was 47 ± 40 months.
  
  
  RESULTS
  Diabetes was the most common reason for sensory neuropathy (79%). Recurrence of CN was seen in 13 feet (23%) with an interval of 27 ± 31 months (range, 3-102 months) after the end of initial immobilization. Patients with recurrence were immobilized for a shorter period of time and had a more advanced stage of CN at time of first diagnosis. Predictors of recurrence were noncompliance (odds ratio 19.7; confidence interval, 4.1-94.4; P < .001) and obesity (odds ratio 6.4; confidence interval, 1.6-25.9; P = .06).
  
  
  CONCLUSIONS
  Recurrence of osteoarthropathic activity is a possible complication after conservative treatment of CN. Obesity and noncompliance are strong predictors for the recurrence of CN.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Department of Orthopedics, University of Zurich, Balgrist, Zurich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Osterhoff
authors.forename: Thomas
authors.initials: T
authors.lastname: Böni
authors.forename: Martin
authors.initials: M
authors.lastname: Berli
mesh_terms: D000208:Acute Disease; D001706:Biopsy; D016022:Case-Control Studies; D002607:Charcot-Marie-Tooth Disease / Q000209:etiology / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D010523:Peripheral Nervous System Diseases / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D012775:Shoes