title: Radiographic and functional results in the treatment of early stages of Charcot neuroarthropathy with a walker boot and immediate weight bearing.
abstract: BACKGROUND
  One of the most common gold standards for the treatment of Charcot neuroarthropathy (CN) in the early Eichenholtz stages I and II is immobilization with the total contact casting and lower limb offloading. However, the total amount of offloading is still debatable.
  
  
  OBJECTIVE
  This study evaluates the clinical and radiographic findings in the treatment of early stages of CN (Eichenholtz stages I and II) with a walker boot and immediate total weight-bearing status.
  
  
  METHODS
  Twenty-two patients with type 2 diabetes mellitus (DM) and CN of Eichenholtz stages I and II were selected for non-operative treatment. All patients were educated about their condition, and full weight bearing was allowed as tolerated. Patients were monitored on a fortnightly basis in the earlier stages, with clinical examination, temperature measurement, and standardized weight-bearing radiographs. Their American Orthopedic Foot and Ankle Society (AOFAS) scores were determined before and after the treatment protocol.
  
  
  RESULTS
  No cutaneous ulcerations or infections were observed in the evaluated cases. The mean measured angles at the beginning and end of the study, although showing relative increase, did not present a statistically significant difference (p > 0.05). Mean AOFAS scores showed a statistically significant improvement by the end of the study (p < 0.005).
  
  
  CONCLUSIONS
  The treatment of early stages of CN (Eichenholtz stages I and II) with emphasis on walker boot and immediate weight bearing has shown a good functional outcome, non-progressive deformity on radiographic assessment, and promising results as a safe treatment option.
authors.affiliation: Division of Endocrinology, University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Candida Ribeiro
authors.initials: MC
authors.lastname: Parisi
authors.forename: Alexandre Leme
authors.initials: AL
authors.lastname: Godoy-Santos
authors.forename: Rafael Trevisan
authors.initials: RT
authors.lastname: Ortiz
authors.forename: Rafael Barban
authors.initials: RB
authors.lastname: Sposeto
authors.forename: Marcos Hideyo
authors.initials: MH
authors.lastname: Sakaki
authors.forename: Marcia
authors.initials: M
authors.lastname: Nery
authors.forename: Tulio Diniz
authors.initials: TD
authors.lastname: Fernandes
keywords: Charcot neuroarthropathy; classification; diabetes; ulceration; weight bearing