What is included in the nonmedical treatment of Charcot arthropathy?

Updated: Jun 21, 2018
  • Author: Mrugeshkumar Shah, MD, MPH, MS; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Immobilization usually is accomplished by casting. Total contact casting (TCC) has been shown to allow patients to ambulate while preventing the progression of deformity. Casts must be checked weekly to evaluate for proper fit, and they should be replaced every 1-2 weeks. Patients with concomitant ulceration must have their casts changed weekly for ulcer evaluation and debridement.

Wang et al studied 21 patients with plantar ulceration associated with diabetic Charcot midfoot neuroarthropathy who were treated either with TCC alone or with TCC plus extended medial column arthrodesis. [15]  Although healing times did not differ significantly between the two groups, patients in the TCC + arthrodesis group had fewer lesions after treatment, and they had no recurrences after 12 months (compared with a 33.3% recurrence rate in the group treated with TCC alone).

Serial plain radiographs should be taken approximately every month during the acute phase to evaluate progress. Casting usually is necessary for 3-6 months and is discontinued on the basis of clinical, radiographic, and dermal thermometric signs of quiescence. Other methods of immobilization include metal braces and ankle-foot orthoses (AFOs), but they may prolong healing times.

Reduction of stress is accomplished by decreasing the amount of weightbearing on the affected extremity. Total nonweightbearing (NWB) is ideal for treatment; however, patients are often not compliant with this treatment. Studies have shown that partial weightbearing (PWB) with assistive devices (eg, crutches, walkers) also is acceptable without compromising healing time. However, full weightbearing (FWB) in the acute phase tends to lengthen total time in the cast.

Healing time varies according to the location of the disease. Pattern 1, or forefoot pathology, heals in two thirds the time needed for pattern 3 or pattern 4. One study revealed that the mean time in a cast is 18.5 weeks, whereas another study showed that the acute phase lasts 12.5 weeks.


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