1
|
McCann LJ, Dickinson JD. Considerations in Charcot Reconstruction. Clin Podiatr Med Surg 2024; 41:141-151. [PMID: 37951671 DOI: 10.1016/j.cpm.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Charcot deformity is a challenging condition often leading to foot and ankle deformity that subsequently causes decreased function, ulceration, infection, and limb loss. There are various treatment measures to take into consideration when managing these patients. Treatment approaches range from conservative casting to surgical reconstruction. The authors believe that when faced with deformity, aggressive reconstruction to maintain a plantigrade foot and prevent loss of function is critical. Because of the nature of the Charcot condition, timing and fixation are often debated. This article discusses the authors' approach to Charcot reconstruction in a large integrated health care system.
Collapse
Affiliation(s)
- Luke J McCann
- Kaiser South San Francisco Medical Center, 1200 El Camino Real, South San Francisco, CA 94108, USA.
| | | |
Collapse
|
2
|
Huynh TM, Pilkey B, Trepman E, Dascal M, Dascal R, Embil JMA. Charcot arthropathy outcomes after early referral to a regional tertiary care foot clinic. Can J Surg 2023; 66:E513-E519. [PMID: 37875304 PMCID: PMC10609890 DOI: 10.1503/cjs.006022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Community physicians may not encounter Charcot arthropathy frequently, and its symptoms and signs may be nonspecific. Patients often have a delay of several months before receiving a formal diagnosis and referral for specialty care. However, limited Canadian data are available. We evaluated the clinical history, treatment and outcomes of patients treated for Charcot arthropathy after prompt referral and diagnosis. METHODS We performed a retrospective chart review of 76 patients with diabetes (78 feet) who received nonoperative treatment for Charcot arthropathy in a specialty foot clinic between Jan. 20, 2009, and Mar. 26, 2018. Patients were referred to the foot clinic by community physicians for evaluation or were pre-existing patients at the foot clinic with new-onset Charcot arthropathy. RESULTS Of the 78 feet included in our analyses, 52 feet (67%) were evaluated initially by a community physician and referred to the foot clinic, where they were seen within 3 ± 5 weeks. The remaining 26 feet (33%) were already being treated at the foot clinic. Most feet had swelling, erythema, warmth, a palpable pulse and loss of protective sensation. Ulcers were present initially in 23 feet (29%). Sixty-four feet (82%) with Charcot arthropathy were in Eichenholtz classification stage 1 and most had midfoot involvement. Nonoperative treatment included total contact casting (60 feet, 77%). Mean duration of nonoperative treatment until resolution for 55 feet (71%) was 6 ± 5 months. Surgery was performed on 20 feet (26%) for the treatment of infection and recurrent ulcer associated with deformity, including 6 (8%) lower limb amputations. CONCLUSION Charcot arthropathy may resolve in most feet with early referral and nonoperative treatment, but remains a limb-threatening condition.
Collapse
Affiliation(s)
- Tiffany M Huynh
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - Brad Pilkey
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - Elly Trepman
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - Mario Dascal
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - Roman Dascal
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| | - John M A Embil
- Department of Surgery, Section of Orthopedic Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Huynh, Pilkey, M. Dascal); Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Trepman, Embil); Faculty of Medicine, University of Manitoba, Winnipeg, Man. (R. Dascal); Section of Infectious Diseases, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Man. (Embil)
| |
Collapse
|
3
|
Julien CA, Ha Van G, M'Bemba J, Bourgeon M, Dardari D, Lepeut M, Dumont I, Zemmache MZ, Serrand C, Bouillet B, Sultan A, Schuldiner S. Real-world treatment patterns and diagnosis of charcot foot in franco-belgian diabetic foot expert centers (The EPiChar Study). Acta Diabetol 2023; 60:1209-1218. [PMID: 37184671 DOI: 10.1007/s00592-023-02101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023]
Abstract
AIM To evaluate the real-life diagnosis and therapeutic means of Charcot Neuroosteoarthropathy (CN) in French-Belgian diabetic foot expert centers. METHODS We collected clinical characteristics, results of exams and therapeutic pathways of consecutive adult patients with diabetic osteoarthropathy seen in consultation or hospitalization from January 1 to December 31, 2019 in 31 diabetic foot expert centers. The primary outcome was to describe the diagnostic and management methods for CN according to patient clinical characteristics, the clinical-radiological characteristics of acute and chronic CN and discharge means. RESULTS 467 patients were included: 364 with chronic CN and 103 in the acute phase. 101 patients had bilateral chronic CN. Most patients were male (73.4%), treated with insulin (73.3%), and with multicomplicated diabetes. In the acute phase, edema and increased foot temperature were present in 75% and 58.3% of cases, respectively. Diagnosis confirmation was usually by MRI and the mode of discharge was variable. In the chronic phase, orthopedic shoes were prescribed in 81.5% of cases. CONCLUSIONS This observational study highlights the diagnostic and therapeutic practices in 31 diabetic foot centers. Our results highlight that the use of MRI and the modalities of offloading, an essential treatment in the acute phase, need to be better standardized. Centers were highly encouraging about creating a patient registry.
Collapse
Affiliation(s)
- Carole-Anne Julien
- Service des Maladies métaboliques et Endocriniennes, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Georges Ha Van
- Service de Diabétologie, AP-HP La Pitié Salpétrière, Paris, France
| | | | - Muriel Bourgeon
- Service Endocrinologie, AP-HP Kremlin Bicêtre, Kremlin Bicêtre, France
| | - Dured Dardari
- Service de Diabétologie, CH Sud Francilien, Corbeil-Essonnes, France
| | - Marc Lepeut
- Service de Diabétologie, CH Roubaix, Roubaix, France
| | | | - Mohammed Zakarya Zemmache
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Chris Serrand
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Benjamin Bouillet
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, CHU Dijon, Dijon, France
| | - Ariane Sultan
- 10PhyMedExp, INSERM U1046, UMR 9214, Univ Montpellier, Service Des Maladies Métaboliques, CHU Montpellier, Montpellier, France
| | - Sophie Schuldiner
- VBIC, INSERM U1047, Univ Montpellier, Service Des Maladies Métaboliques Et Endocriniennes, CHU Nîmes, Clinique du Pied Gard Occitanie, Route de Carnon, 30240, Le Grau du Roi, France.
| |
Collapse
|
4
|
Wadhera S, Rastogi A, Dutta P, Gupta A, Bhadada SK. Age and Disease Duration Independent Cardiac Autonomic Neuropathy in Patients with Diabetic Foot Complications: Case-Control Study. Indian J Endocrinol Metab 2022; 26:362-371. [PMID: 36185960 PMCID: PMC9519835 DOI: 10.4103/ijem.ijem_99_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Cardiac autonomic neuropathy (CAN) in people with diabetes is associated with high mortality. We aimed to study age and disease duration, independent prevalence of CAN in people with diabetic foot complications. METHODS 530 patients with diabetes were screened to undergo CAN assessment (automated CANS-analyser). CAN was defined as "early", "definite," or "severe" according to the Toronto consensus. History pertaining to autonomic symptoms, prior cardiovascular events (CVE), and assessment for peripheral neuropathy was done. Participants were grouped into those with diabetic foot complication (group A, n = 82) [Charcot foot (n = 42), diabetic foot ulcer (n = 40)]; with DPN without foot complications (group B, n = 82); and without DPN or foot complications (group C, n = 82). RESULTS Symptoms of autonomic dysfunction were prominent in people with foot complications than the other groups. Resting heart rate was significantly greater in those with foot complications [99.89 ± 26.71 (group A) vs. 86.99 ± 22.24 (group B) vs. 88.32 ± 17.08 (group C); P = 0.001]. The prevalence of CAN was 75.6% in group A (51.2% early, 12.2% definite, 12.2% severe), 57.2% in group B (45.1% early, 12.2% severe) and 58.5% in group C (43.9% early, 1.2% definite, 13.4% severe) (P = 0.002). Patients with foot complications were more likely to have CAN (75.6% vs. 57.9%, P < 0.001). Charcot foot had higher prevalence of CAN (78.6%) as compared with those with DFU (72.5%) or without DFU or DPN (57.9%), P < 0.001. CONCLUSION CAN is present in more than two-third of patients with diabetes and foot complications with highest prevalence in Charcot neuroarthropathy.
Collapse
Affiliation(s)
- Sarthak Wadhera
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Gupta
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay K. Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
5
|
Каландия ММ, Токмакова АЮ, Галстян ГР. [The role of glycation end products in the development and progression of diabetic neuroarthropathy]. PROBLEMY ENDOKRINOLOGII 2021; 67:4-9. [PMID: 34297497 PMCID: PMC9112848 DOI: 10.14341/probl12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/04/2021] [Accepted: 07/04/2021] [Indexed: 12/16/2022]
Abstract
Diabetic neuroarthropathy (DNOAP, Charcot's foot) is a serious complication of diabetes mellitus, the genesis of which is not fully understood. In most cases, this pathology is diagnosed late, which leads to the development of severe deformities of the foot, up to the loss of support ability of the limb. There is no single hypothesis for the formation of Charcot's foot, but there are factors predisposing to its development, as well as a few likely provoking events. Excessive formation and accumulation of end products of glycation may play an important role in the pathogenesis of this complication of diabetes. End products of glycation (AGE) are a variety of compounds formed as a result of a non-enzymatic reaction between carbohydrates and free amino groups of proteins, lipids and nucleic acids. There are various factors that lead to the accumulation of AGE in the human body. Allocate endogenous and exogenous factors. The former include certain diseases, such as diabetes mellitus, renal failure, which accelerate glycation processes. Exogenous factors leading to the formation of lipo-oxidation and glyco-oxidation products include tobacco smoke and prolonged heat treatment of food.This review provides information on the role of glycation end products in the development and progression of complications in patients with diabetes mellitus.
Collapse
Affiliation(s)
- М. М. Каландия
- Национальный медицинский исследовательский центр эндокринологии
| | - А. Ю. Токмакова
- Национальный медицинский исследовательский центр эндокринологии
| | - Г. Р. Галстян
- Национальный медицинский исследовательский центр эндокринологии
| |
Collapse
|
6
|
Bandeira MA, Dos Santos ALG, Woo K, Gamba MA, de Gouveia Santos VLC. Incidence and Predictive Factors for Amputations Derived From Charcot's Neuroarthropathy in Persons With Diabetes. INT J LOW EXTR WOUND 2021:15347346211025893. [PMID: 34142879 DOI: 10.1177/15347346211025893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Charcot's neuroarthropathy (CN) is the progressive destruction of the bones and joints of the feet, as a consequence of severe peripheral neuropathy, which predisposes patients to amputations. The purpose of this study was to measure the cumulative incidence of amputations resulting from CN and risk factors among amputated people with diabetes mellitus (DM). This was an epidemiological, observational, and retrospective study of 114 patients with DM who had an amputation involving the lower limbs. Data were collected from 2 specialized outpatient clinics between 2015 and 2019, including socio-demographic and clinical variables (cause of amputation: CN, peripheral arterial disease [PAD], infected ulcers, fracture, osteomyelitis, and others; body mass index [BMI]; 1 or 2 DM, time since DM diagnosis, insulin treatment, glycated hemoglobin; creatinine; smoking and drinking; systemic arterial hypertension, diabetic retinopathy, diabetic kidney disease, diabetic peripheral neuropathy, acute myocardial infarction, PAD, and stroke; characteristics of amputation [level and laterality], in addition to the specific variables related to CN [time of amputation in relation to the diagnosis of CN, diagnosis of CN in the acute phase, and treatment implemented in the acute phase]). We compared socio-demographic and clinical characteristics, including types of amputation, between patients with and without CN. Statistical analyses were performed using the 2 sample t-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the possible association of predictive factors for a CN amputation was carried out through logistic regression. The amputation caused by CN was present in 27 patients with a cumulative incidence of 23.7% in 5 years. There was a statistically significant association between BMI and the occurrence of CN (odds ratio: 1.083; 95% confidence interval: 1.001-1.173; P = .048); higher values of BMI were associated with a higher occurrence of amputations secondary from CN.
Collapse
Affiliation(s)
| | | | - Kevin Woo
- 4257Queen's University, Kingston, Ontario, Canada
| | | | | |
Collapse
|
7
|
Young J. Foot Shape and Asymmetry in the Charcot Foot: Assessment Using the Foot Posture Index. J Am Podiatr Med Assoc 2020; 110:Article4. [PMID: 32073321 DOI: 10.7547/17-157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Charcot neuroarthropathy (CN), or the Charcot foot, is a complication usually associated with diabetes that frequently results in changes in foot shape and structure that have an effect on function and risk of ulceration. This study aimed to assess foot shape and asymmetry in CN using the Foot Posture Index (FPI-6). METHODS Case notes of patients with CN seen in a diabetic orthotic clinic were reviewed, and available FPI-6 data were analyzed. A comparison group of patients with diabetes without CN was also identified. Groups were compared according to published ranges of foot posture and asymmetry using the Fisher exact test. RESULTS Twenty-seven patients with CN with 28 affected feet and a comparison group of 27 patients with diabetes only were identified. There was large variation in FPI-6 scores in affected (1 to 12) and unaffected (-1 to 10) feet. Mean scores for affected feet (6.82) and unaffected feet (5.05) differed significantly (P = .005). Considering all FPI-6 scores as positive numbers to indicate mean absolute difference between affected and unaffected feet, CN-affected feet differed by a mean of 3.00 points from unaffected feet. Patients in the CN group were less likely to have asymmetry in the normal range than the comparison group (P = .0146). CONCLUSIONS This study provides new data on foot shape after CN. Patients with CN have feet that are significantly asymmetrical, and the affected foot may be more pronated or supinated. Feet affected by CN are characterized by shape, which is more frequently outside the normal range. The FPI-6 may be suitable for more widespread use in assessment and outcome measurement.
Collapse
Affiliation(s)
- Joshua Young
- St. Georges University Hospitals NHS Foundation Trust, Orthotic Department, Queen Mary's Hospital, Roehampton, SW15 5PN, United Kingdom. (E-mail: )
| |
Collapse
|
8
|
New Concepts in the Management of Charcot Neuroarthropathy in Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:391-415. [PMID: 32124412 DOI: 10.1007/5584_2020_498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Charcot Neuroarthropathy (CN) is an uncommon, debilitating and often underdiagnosed complication of chronic diabetes mellitus though, it can also occur in other medical conditions resulting from nerve injury. Till date, the etiology of CN remains unknown, but enhanced osteoclastogenesis is believed to play a central role in the pathogenesis of CN, in the presence of neuropathy. CN compromises the overall health and quality of life. Delayed diagnosis can result in a severe deformity that can act as a gateway to ulceration, infection and in the worst case, can lead to limb loss. In an early stage of CN, immobilization with offloading plays a key role to a successful treatment. Medical therapies seem to have limited role in the treatment of CN.In case of severe deformity, proper footwear or bracing may help prevent further deterioration and development of an ulcer. In individuals with a concomitant ulcer with osteomyelitis, soft tissue infection and severe deformity, where conservative measures fall short, surgical intervention becomes the only choice of treatment. Early diagnosis and proper management at an early stage can help prevent the occurrence of CN and amputation.
Collapse
|
9
|
Naik D, Singh HS, Gupta RD, Jebasingh F, Paul TV, Thomas N. Prevalence and patterns of cardiac autonomic dysfunction in male patients with type 2 diabetes mellitus and chronic Charcot’s neuroarthropathy: a cross-sectional study from South India. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
10
|
Jansen RB, Jørgensen B, Holstein PE, Møller KK, Svendsen OL. Mortality and complications after treatment of acute diabetic Charcot foot. J Diabetes Complications 2018; 32:1141-1147. [PMID: 30301593 DOI: 10.1016/j.jdiacomp.2018.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 11/22/2022]
Abstract
AIMS Charcot foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot foot on a case-by-case basis, in order to assess the consequences of an acute Charcot foot and its complications. METHODS The study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry. RESULTS In total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7 ± 21.4 mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5 ± 20.3 mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3 months). The 5-year mortality was 14% with a mean survival time of 12.7 years. There was an association between lack of compliance and occurrence of foot complications, as well as between having a Charcot foot and leaving the workforce. CONCLUSION More patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot foot.
Collapse
Affiliation(s)
- Rasmus Bo Jansen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark.
| | - Bo Jørgensen
- Center for Wound Healing, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark
| | - Per E Holstein
- Center for Wound Healing, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark
| | - Klaus Kirketerp Møller
- Center for Wound Healing, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark
| | - Ole Lander Svendsen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark
| |
Collapse
|
11
|
Vopat ML, Nentwig MJ, Chong AC, Agan JL, Shields NN, Yang SY. Initial Diagnosis and Management for Acute Charcot Neuroarthropathy. Kans J Med 2018; 11:114-119. [PMID: 30937152 PMCID: PMC6276967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Matthew L. Vopat
- University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS
| | - Michelle J. Nentwig
- University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS
| | - Alexander C.M. Chong
- University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS,Via Christi Health, Wichita, KS
| | | | - Naomi N. Shields
- University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS,Advanced Orthopaedics Associates, Wichita, KS
| | - Shang-You Yang
- University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS
| |
Collapse
|
12
|
Metcalf L, Musgrove M, Bentley J, Berrington R, Bunting D, Mousley M, Thompson J, Sprengel M, Turtle-Savage V, Game F, Jeffcoate W. Prevalence of active Charcot disease in the East Midlands of England. Diabet Med 2018; 35:1371-1374. [PMID: 29782669 DOI: 10.1111/dme.13679] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Abstract
AIMS To undertake a prospective point prevalence study of the prevalence of active Charcot neuro-inflammatory osteoarthropathy (Charcot disease) in a circumscribed part of England and to audit the time elapsing between disease onset and first diagnosis. METHODS The prevalence of active Charcot disease of the foot during a single month was assessed by specialist foot care teams at seven secondary care services in the East Midlands region of England. RESULTS A total of 90 cases were identified, representing 4.3 per 10 000 of the 205 033 total diabetes population of the region. The time elapsed from first presentation to any healthcare professional until diagnosis was also assessed. While the diagnosis was suspected or confirmed in one-third of patients within 2 weeks, it was not made for 2 months or more in 23 patients (24%). CONCLUSIONS Non-specialist professionals should have greater awareness of the existence of this uncommon complication of diabetes in the hope that earlier diagnosis will lead to lesser degrees of deformity.
Collapse
Affiliation(s)
- L Metcalf
- Nottingham Healthcare NHS Foundation Trust Nottingham, Nottingham, UK
| | - M Musgrove
- Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, Nottingham, UK
| | - J Bentley
- Lincolnshire Community Health Services NHS Trust, Lincoln, UK
| | - R Berrington
- University Hospitals Leicester NHS Trust, Leicester, UK
| | - D Bunting
- Derbyshire Community Health Services NHS Foundation Trust, Derby, UK
| | - M Mousley
- Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - J Thompson
- Nottingham Healthcare NHS Foundation Trust Nottingham, Nottingham, UK
| | - M Sprengel
- Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, Nottingham, UK
| | - V Turtle-Savage
- Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, Nottingham, UK
| | - F Game
- Diabetes and Endocrinology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - W Jeffcoate
- Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, Nottingham, UK
| |
Collapse
|
13
|
Thewjitcharoen Y, Sripatpong J, Parksook W, Krittiyawong S, Porramatikul S, Srikummoon T, Mahaudomporn S, Nakasatien S, Himathongkam T. Salient features and outcomes of Charcot foot - An often-overlooked diabetic complication: A 17-year-experience at a diabetic center in Bangkok. J Clin Transl Endocrinol 2018; 11:1-6. [PMID: 29725580 PMCID: PMC5928004 DOI: 10.1016/j.jcte.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Charcot foot is a rare but a serious diabetic condition. Recognition of this often overlooked condition to provide timely and proper management is important for a better prognosis. Limited data on Charcot foot was available in Asians. AIMS The aim of this study is to describe salient features and outcomes of Charcot foot in Thai patients. METHOD We presented our experience of 40 cases of Charcot foot patients who were treated from 2000 to 2016 at Theptarin Hospital, Bangkok, Thailand. RESULTS A total of 40 Charcot foot patients were identified (13 acute, 27 chronic; mean age 58.7 ± 10.2 years; duration of diabetes 18.0 ± 8.8 years; T2DM 95%). The average serum HbA1c level was 9.2 ± 1.9%. While acute Charcot foot was frequently misdiagnosed as cellulitis in almost one-third of patients, osteomyelitis was a leading cause of misdiagnosis in 15% of chronic Charcot foot patients. Ulcer-free rate at 6 and 12 months were observed in 60% and 58% of patients, respectively. The mortality rate was 13% during a median follow-up period of 57 months. Only 61% of the patients resumed walking normally while almost one-fourth of them were wheelchair-bound. CONCLUSIONS Charcot foot in Thai patients mainly developed in long-standing poorly controlled type 2 diabetes with neuropathy, and presented late in the course of the disease. It was often misdiagnosed resulting in improper management and poor outcome which included amputation.
Collapse
Affiliation(s)
- Yotsapon Thewjitcharoen
- Diabetes and Thyroid Center, Theptarin Hospital, 3858 Rama IV Rd, Klong Toey, Bangkok 10110, Thailand
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Salini D, Harish K, Minnie P, Sundaram KR, Arun B, Sandya CJ, Mangalanandan TS, Vivek L, Praveen VP. Prevalence of Charcot Arthropathy in Type 2 Diabetes Patients Aged over 50 Years with Severe Peripheral Neuropathy: A Retrospective Study in a Tertiary Care South Indian Hospital. Indian J Endocrinol Metab 2018; 22:107-111. [PMID: 29535947 PMCID: PMC5838888 DOI: 10.4103/ijem.ijem_257_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS Available literature on the prevalence of Charcot arthropathy (CA) represents mainly Western population. No study has been reported from India so far. Hence we attempted to study the prevalence of CA in patients with type 2 diabetes mellitus and severe peripheral neuropathy (T2DMPN), belonging to Indian population amongst whom type 2 diabetes is on the rise in alarming proportions. MATERIALS AND METHODS Medical records of 3387 patients who performed an objective vibration perception threshold test during the year 2015 were screened for T2DMPN. Out of these, 1475 T2DMPN patients above 50 years were selected and analyzed in detail for CA. CA was diagnosed based on clinical features and/or radiological investigations. The anatomical localization of the disease distribution of the affected foot was done according to Brodsky's classification. RESULTS The prevalence of CA in T2DMPN patients was found to be 9.8%. The mean age of patients diagnosed with CA was 63 ± 8.36 years, and mean duration of DM for CA to develop was 18.01 ± 8.23 years. About 62.5% of the patients were male and 37.5% female. Bilateral presentation of CA was observed in 20.8% of patients. Multiple sites of the foot were affected in 48.6% of patients and belonged to type 4 classification of Brodsky. CONCLUSIONS A high prevalence of CA (9.8%) was observed in the present study conducted on T2DMPN patients who presented to the endocrinology department of a tertiary care South Indian hospital. In the majority of patients, the area of foot affected belonged to type 4 classification of Brodsky.
Collapse
Affiliation(s)
- Dharmadas Salini
- Department of Anatomy, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Kumar Harish
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Pillay Minnie
- Department of Anatomy, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Karimassery R. Sundaram
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Bal Arun
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Chirukandath J. Sandya
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Thacho S. Mangalanandan
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Lakshmanan Vivek
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Valiyaparambil P. Praveen
- Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| |
Collapse
|
15
|
Dekker RG, Qin C, Ho BS, Kadakia AR. The effect of cumulative glycemic burden on the incidence of diabetic foot disease. J Orthop Surg Res 2016; 11:143. [PMID: 27863489 PMCID: PMC5116195 DOI: 10.1186/s13018-016-0474-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Glycemic control is a known modifiable risk factor for diabetic foot disease. Prior attempts to define its relationship with diabetic foot ulcer and Charcot arthropathy fail to account for variability in control and duration of diabetic disease. We developed a novel metric to reflect aggregate disease exposure in a diabetic, termed cumulative glycemic burden. We hypothesized that it would be positively associated with both diabetic foot ulcer and radiographically diagnosed Charcot arthropathy. METHODS Patients aged 18 to 90 years with ≥3 hemoglobin A1c (HbA1c) values were identified retrospectively at a single institution over a 15-year period. Primary outcomes were ICD-9 diagnosis of foot ulcer and radiographically diagnosed Charcot arthropathy. Cumulative glycemic burden was calculated by trapezoidal integration of the area under a curve defined by HbA1c values above 7 over time. Patients were stratified into quartiles based on cumulative glycemic burden (excellent, good, fair, and poor control). χ 2 tests compared the proportion of foot ulcer and Charcot across quartiles. Regression analysis identified associated demographic and comorbidity factors with diabetic foot disease. Statistical significance was set at P < .05. RESULTS Out of 22,913 diabetics, 1643 (7.2%) had a foot ulcer; 54 out of 771 diabetics (7.0%) had radiographic Charcot arthropathy. There was a statistically significant stepwise increase in the incidence of foot ulcer with increasing cumulative glycemic burden by patient quartile (5.2 vs. 6.4 vs. 7.9 vs. 13.9%; P < .001). No significant trend was seen between incidence of Charcot arthropathy and greater cumulative glycemic burden (7.8 vs. 5.6 vs. 4.4 vs. 10.0%; P = .469). Peripheral vascular disease was most strongly associated with diabetic foot ulcer. Hypertension and diabetic neuropathy were independently associated with Charcot arthropathy. CONCLUSIONS Increasing cumulative glycemic burden is positively associated with diabetic foot ulcer. Greater attention should be paid towards the most poorly controlled diabetics with the longest duration of disease to reduce their risk. Cumulative glycemic burden is not associated with Charcot arthropathy.
Collapse
Affiliation(s)
- Robert G Dekker
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Charles Qin
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Bryant S Ho
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
| | - Anish R Kadakia
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| |
Collapse
|