What is the prognosis of Charcot arthropathy?

Updated: Mar 23, 2020
  • Author: Mrugeshkumar Shah, MD, MPH, MS; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Outcomes for Charcot arthropathy are based on immediate diagnosis and treatment. A more favorable outcome is elicited when joints are treated within 2 weeks of injury and when there is strict adherence to weightbearing precautions.

Healing time is increased in diabetics. Location of the disease also affects outcome. Forefoot arthropathies heal in less time than midfoot, hindfoot, or ankle arthropathies, as the following list illustrates:

  • Ankle - Mean healing time, 83 ± 22 days
  • Hindfoot - Mean healing time, 97 ± 16 days
  • Midfoot - Mean healing time, 96 ± 11 days
  • Forefoot - Mean healing time, 55 ± 17 days

The extent of the injury also affects healing time. The more severe the injury, the longer it takes to heal and the greater the likelihood of permanent deformity. It generally takes 1-2 years to completely heal a Charcot joint, from the active phase to quiescence.

Stark et al performed a 5-year retrospective analysis of 50 patients presenting to a tertiary foot clinic with acute Charcot neuroarthropathy, with the aims of (1) determining whether the initial immobilization approach (total-contact casting [TCC] or use of a removable offloading device) influenced time to resolution, (2) determining the relapse rate after TCC use, and (3) determining whether neuroarthropathy location influenced time to resolution. [8]  Of the 50 patients, 42 went into remission; 36 were treated with both TCC and removable offloading, five with removable offloading only, and one with TCC only.

Median time to resolution for patients initially treated with TCC was 48 weeks, compared with 53 weeks for those initially treated with a removable offloading device; however, the difference was not significant (P = 0.7681). [8] A relapse rate of 34.9% was noted for patients who were treated with TCC at any point. The location of the neuroarthropathy did not have a significant effect on time to resolution in this study.

Lee et al studied factors influencing outcomes after tibiotalocalcaneal fusion using a retrograde intramedullary (IM) nail in 34 patients followed for a minimum of 2 years. [9]  Throughout follow-up, standard ankle radiography was performed along with clinical outcome assessment using a visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society Ankle-Hind Foot Scale (AOFAS A/H scale) and the Foot and Ankle Outcome Score (FAOS). Demographic factors, preoperative medical status, laboratory markers, and etiology were comprehensively reviewed. The success of the index operation was determined on the basis of clinical and radiologic outcomes.

In a mean of 7 months, 28 of the 34 patients (82%) achieved union on standard radiography. [9]  All clinical outcome parameters improved significantly. At final follow-up, five cases of nonunion with AOFAS A/H scale less than 80 and two cases of below-knee amputation due to uncontrolled infection were determined to be failures. Failure was not significantly influenced by etiology, demographics, laboratory markers, or medical status. However, uncontrolled diabetes mellitus significantly increased the failure rate, suggesting that this procedure should be used judiciously in patients with this condition.


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