Role of the General Surgeon in the Early Diagnosis and Treatment of Charcot Foot.
BACKGROUND
The Charcot foot (CF) consists of a progressive deterioration of the bones and joints, most common in diabetic patients with advanced neuropathy. The great problem is that can be confused with other processes, delaying the diagnosis and specific treatment. The aim is to analyze the cases of CF diagnosed in our hospital and especially to highlight the role of the general surgeon.


METHODS
Retrospective study of all registered cases diagnosed of CF between the diabetic population of our Department of Health. A review of the literature was performed.


RESULTS
From 2008 to 2012, there 7 cases of CF were diagnosed (prevalence 1:710). Two of the patients were diagnosed erroneously of cellulitis. The average time of delay in the diagnosis was 10 weeks (minimum 1, maximum 24). The initial treatment was immobilization of the extremity. Once the edema was eliminated, an offload orthesis was placed according to Sanders's anatomical classification. Evolution was favorable in 5 patients, 1 patient needed amputation, and other one died of acute cardiac pathology.


CONCLUSIONS
The CF is a more frequent pathology than we believe. The general surgeon is the fundamental prop in the diagnosis and initial treatment. Before the presence of inflammation and edema of the foot in a patient with diabetes and severe neuropathy, once cellulitis, osteomyelitis, and TVP are ruled out, Charcot neuroarthropathy should be considered.
Servicio de Cirugía General, Hospital Arnau de Vilanova, Valencia, España. Electronic address: rafaselles@yahoo.es.
Rafael
R
Sellés Dechent
Servicio de Cirugía General, Hospital Arnau de Vilanova, Valencia, España.
Camilo
C
Rueda Alcárcel
Servicio de Cirugía General, Hospital Arnau de Vilanova, Valencia, España.
Vicent
V
Primo Romaguera
Servicio de Cirugía General, Hospital Arnau de Vilanova, Valencia, España.
Asunción
A
Martínez Caamaño
Servicio de Cirugía General, Hospital Arnau de Vilanova, Valencia, España.
Francisco
F
Asencio Arana
D000368:Aged; D001177:Arthropathy, Neurogenic / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D005534:Foot Diseases / Q000175:diagnosis*; D013502:General Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D012189:Retrospective Studies
Charcot foot; Charcot neuroarthropathy; Diabetes.; Neuroartropatía de Charcot; Pie de Charcot