What are the NICE diagnostic guidelines for 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

The National Institute for Health and Care Excellence (NICE) of the United Kingdom has published a guideline for the prevention and management of diabetic foot disorders. [26] Recommendations specifically relevant to Charcot arthropathy in diabetes are as follows.

Investigation

It must be kept in mind that if a person with diabetes fractures a foot or ankle, the fracture may progress to Charcot arthropathy.

Acute Charcot arthropathy should be suspected if redness, warmth, swelling, or deformity (particularly if the skin is intact) is noted, especially in the presence of peripheral neuropathy or renal failure. Acute Charcot arthropathy should be considered even when deformity is not present or pain is not reported.

For confirmation of the diagnosis of acute Charcot arthropathy, the patient should be referred within 1 working day to the multidisciplinary foot care service for triage within 1 further working day. Nonweightbearing (NWB) treatment should be offered until the multidisciplinary foot care service can initiate definitive treatment.

If acute Charcot arthropathy is suspected, a weightbearing radiograph of the affected foot and ankle should be obtained. Magnetic resonance imaging (MRI) may be considered if the radiograph is normal but Charcot arthropathy is still suspected.


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