The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic

D. G. Armstrong, W. F. Todd, L. A. Lavery, L. B. Harkless, T. R. Bushman

Research output: Contribution to journalArticle

209 Citations (Scopus)

Abstract

The aim of this longitudinal study was to report on the clinical characteristics and treatment course of acute Charcot's arthropathy at a tertiary care diabetic foot clinic. Fifty-five diabetic subjects, with a mean age of 58.6 ± 8.5 years, were studied. All patients were treated with serial total contact casting until quiescence. Following casting and before transfer to prescription footwear, patients were eased into unprotected weightbearing via a removable cast walker. This cohort was followed for their entire treatment course and for a mean 92.6 ± 33.7 weeks following return to shoes. Pain was the most frequent presenting complaint in these otherwise insensate patients (76%). The mean duration of casting was 18.5 ± 10.6 weeks. Patients returned to footwear in a mean 28.3 ± 14.5 weeks. Nine per cent of the population had bilateral arthropathy. These subjects were casted significantly longer than the unilateral group (p < 0.02). Surgery was performed on 25% of patients, with approximately two-thirds of these procedures involving plantar exostectomies and one-third fusions of affected joints. Patients receiving surgery remained casted significantly longer than non-surgical patients (p < 0.05). Additionally, men were casted longer than women (p < 0.008). Acute Charcot's arthropathy requires prompt, uncompromising reduction in weightbearing stress. Our data show that the ambulatory total contact cast is very effective for this. Regardless of the specific treatment method instituted, it is imperative that appropriate and aggressive treatment be undertaken immediately following diagnosis to help prevent progression to a profoundly debilitating, limb-threatening deformity.

Original languageEnglish (US)
Pages (from-to)357-363
Number of pages7
JournalDiabetic Medicine
Volume14
Issue number5
DOIs
StatePublished - 1997

Fingerprint

Diabetic Foot
Joint Diseases
Natural History
Weight-Bearing
Shoes
Tertiary Healthcare
Therapeutics
Prescriptions
Longitudinal Studies
Extremities
Joints
Pain
Population

Keywords

  • Charcot's arthropathy

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic. / Armstrong, D. G.; Todd, W. F.; Lavery, L. A.; Harkless, L. B.; Bushman, T. R.

In: Diabetic Medicine, Vol. 14, No. 5, 1997, p. 357-363.

Research output: Contribution to journalArticle

Armstrong, D. G. ; Todd, W. F. ; Lavery, L. A. ; Harkless, L. B. ; Bushman, T. R. / The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic. In: Diabetic Medicine. 1997 ; Vol. 14, No. 5. pp. 357-363.
@article{974b2700eb5f4724af026fca16d3f98e,
title = "The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic",
abstract = "The aim of this longitudinal study was to report on the clinical characteristics and treatment course of acute Charcot's arthropathy at a tertiary care diabetic foot clinic. Fifty-five diabetic subjects, with a mean age of 58.6 ± 8.5 years, were studied. All patients were treated with serial total contact casting until quiescence. Following casting and before transfer to prescription footwear, patients were eased into unprotected weightbearing via a removable cast walker. This cohort was followed for their entire treatment course and for a mean 92.6 ± 33.7 weeks following return to shoes. Pain was the most frequent presenting complaint in these otherwise insensate patients (76{\%}). The mean duration of casting was 18.5 ± 10.6 weeks. Patients returned to footwear in a mean 28.3 ± 14.5 weeks. Nine per cent of the population had bilateral arthropathy. These subjects were casted significantly longer than the unilateral group (p < 0.02). Surgery was performed on 25{\%} of patients, with approximately two-thirds of these procedures involving plantar exostectomies and one-third fusions of affected joints. Patients receiving surgery remained casted significantly longer than non-surgical patients (p < 0.05). Additionally, men were casted longer than women (p < 0.008). Acute Charcot's arthropathy requires prompt, uncompromising reduction in weightbearing stress. Our data show that the ambulatory total contact cast is very effective for this. Regardless of the specific treatment method instituted, it is imperative that appropriate and aggressive treatment be undertaken immediately following diagnosis to help prevent progression to a profoundly debilitating, limb-threatening deformity.",
keywords = "Charcot's arthropathy",
author = "Armstrong, {D. G.} and Todd, {W. F.} and Lavery, {L. A.} and Harkless, {L. B.} and Bushman, {T. R.}",
year = "1997",
doi = "10.1002/(SICI)1096-9136(199705)14:5<357::AID-DIA341>3.0.CO;2-8",
language = "English (US)",
volume = "14",
pages = "357--363",
journal = "Diabetic Medicine",
issn = "0742-3071",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic

AU - Armstrong, D. G.

AU - Todd, W. F.

AU - Lavery, L. A.

AU - Harkless, L. B.

AU - Bushman, T. R.

PY - 1997

Y1 - 1997

N2 - The aim of this longitudinal study was to report on the clinical characteristics and treatment course of acute Charcot's arthropathy at a tertiary care diabetic foot clinic. Fifty-five diabetic subjects, with a mean age of 58.6 ± 8.5 years, were studied. All patients were treated with serial total contact casting until quiescence. Following casting and before transfer to prescription footwear, patients were eased into unprotected weightbearing via a removable cast walker. This cohort was followed for their entire treatment course and for a mean 92.6 ± 33.7 weeks following return to shoes. Pain was the most frequent presenting complaint in these otherwise insensate patients (76%). The mean duration of casting was 18.5 ± 10.6 weeks. Patients returned to footwear in a mean 28.3 ± 14.5 weeks. Nine per cent of the population had bilateral arthropathy. These subjects were casted significantly longer than the unilateral group (p < 0.02). Surgery was performed on 25% of patients, with approximately two-thirds of these procedures involving plantar exostectomies and one-third fusions of affected joints. Patients receiving surgery remained casted significantly longer than non-surgical patients (p < 0.05). Additionally, men were casted longer than women (p < 0.008). Acute Charcot's arthropathy requires prompt, uncompromising reduction in weightbearing stress. Our data show that the ambulatory total contact cast is very effective for this. Regardless of the specific treatment method instituted, it is imperative that appropriate and aggressive treatment be undertaken immediately following diagnosis to help prevent progression to a profoundly debilitating, limb-threatening deformity.

AB - The aim of this longitudinal study was to report on the clinical characteristics and treatment course of acute Charcot's arthropathy at a tertiary care diabetic foot clinic. Fifty-five diabetic subjects, with a mean age of 58.6 ± 8.5 years, were studied. All patients were treated with serial total contact casting until quiescence. Following casting and before transfer to prescription footwear, patients were eased into unprotected weightbearing via a removable cast walker. This cohort was followed for their entire treatment course and for a mean 92.6 ± 33.7 weeks following return to shoes. Pain was the most frequent presenting complaint in these otherwise insensate patients (76%). The mean duration of casting was 18.5 ± 10.6 weeks. Patients returned to footwear in a mean 28.3 ± 14.5 weeks. Nine per cent of the population had bilateral arthropathy. These subjects were casted significantly longer than the unilateral group (p < 0.02). Surgery was performed on 25% of patients, with approximately two-thirds of these procedures involving plantar exostectomies and one-third fusions of affected joints. Patients receiving surgery remained casted significantly longer than non-surgical patients (p < 0.05). Additionally, men were casted longer than women (p < 0.008). Acute Charcot's arthropathy requires prompt, uncompromising reduction in weightbearing stress. Our data show that the ambulatory total contact cast is very effective for this. Regardless of the specific treatment method instituted, it is imperative that appropriate and aggressive treatment be undertaken immediately following diagnosis to help prevent progression to a profoundly debilitating, limb-threatening deformity.

KW - Charcot's arthropathy

UR - http://www.scopus.com/inward/record.url?scp=0030975898&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030975898&partnerID=8YFLogxK

U2 - 10.1002/(SICI)1096-9136(199705)14:5<357::AID-DIA341>3.0.CO;2-8

DO - 10.1002/(SICI)1096-9136(199705)14:5<357::AID-DIA341>3.0.CO;2-8

M3 - Article

C2 - 9171250

AN - SCOPUS:0030975898

VL - 14

SP - 357

EP - 363

JO - Diabetic Medicine

JF - Diabetic Medicine

SN - 0742-3071

IS - 5

ER -