scholarly journals Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Danielle A. Griffiths ◽  
Michelle R. Kaminski
Keyword(s):  
Traumatic Injury ◽  
Delayed Diagnosis ◽  
Signs And Symptoms ◽  
Joint Disease ◽  
Asia Pacific ◽  
Foot And Ankle ◽  
Charcot Foot ◽  
Charcot Neuroarthropathy ◽  
Inflammatory Phase ◽  
Total Contact Casting

Abstract Background Charcot neuroarthropathy (Charcot foot) is a highly destructive joint disease of the foot and ankle. If there is delayed diagnosis and treatment, it can lead to gross deformity, instability, recurrent ulceration and/or amputation. Total contact casting (TCC) is a treatment commonly used to immobilise the foot and ankle to prevent trauma, further destruction and preserve the foot structure during the inflammatory phase. At present, there is limited Australian data regarding the duration of TCC treatment for resolution of acute Charcot foot, and whether there are any patient and clinical factors affecting its duration. Therefore, this study aimed to address these deficiencies. Methods This study presents a retrospective analysis of 27 patients with acute Charcot foot attending for TCC treatment at a high-risk foot service (HRFS) in a large metropolitan health network in Melbourne, Australia. Over a three-year period, data were retrospectively collected by reviewing hospital medical records for clinical, demographic, medical imaging and foot examination information. To explore between-group differences, independent samples t-tests, Mann-Whitney U tests, Chi-square tests, and/or Fisher’s exact tests were calculated depending on data type. To evaluate associations between recorded variables and duration of TCC treatment, mean differences, odds ratios (OR) and 95% confidence intervals were calculated. Results Mean age was 57.9 (SD, 12.6) years, 66.7% were male, 88.9% had diabetes, 96.3% had peripheral neuropathy, and 33.3% had peripheral arterial disease. Charcot misdiagnosis occurred in 63.0% of participants, and signs and symptoms consistent with acute Charcot foot were present for a median of 2.0 (IQR, 1.0 to 6.0) months prior to presenting or being referred to the HRFS. All participants had stage 1 Charcot foot. Of these, the majority were located in the tarsometatarsal joints (44.4%) or midfoot (40.7%) and were triggered by an ulcer or traumatic injury (85.2%). The median TCC duration for resolution of acute Charcot foot was 4.3 (IQR, 2.7 to 7.8) months, with an overall complication rate of 5% per cast. Skin rubbing/irritation (40.7%) and asymmetry pain (22.2%) were the most common TCC complications. Osteoarthritis was significantly associated with a TCC duration of more than 4 months (OR, 6.00). Post TCC treatment, 48.1% returned to footwear with custom foot orthoses, 25.9% used a life-long Charcot Restraint Orthotic Walker, and 22.2% had soft tissue or bone reconstructive surgery. There were no Charcot recurrences, however, contralateral Charcot occurred in 3 (11.1%) participants. Conclusions The median TCC duration for resolution of acute Charcot foot was 4 months, which is shorter or comparable to data reported in the United Kingdom, United States, Europe, and other Asia Pacific countries. Osteoarthritis was significantly associated with a longer TCC duration. The findings from this study may assist clinicians in providing patient education, managing expectations and improving adherence to TCC treatment for acute Charcot neuroarthropathy cases in Australia.

Limb Salvage in Charcot Foot and Ankle Osteomyelitis: Combined Use Single Stage/Double Stage of Arthrodesis and External Fixation

2009 ◽  
Vol 30 (11) ◽  
pp. 1065-1070 ◽  
Author(s):  
Luca Dalla Paola ◽  
Tanja Ceccacci ◽  
Sasa Ninkovic ◽  
Sara Sorgentone ◽  
Maria Grazia Marinescu
Keyword(s):  
External Fixation ◽  
Limb Salvage ◽  
Single Stage ◽  
Foot And Ankle ◽  
Charcot Foot ◽  
Combined Use

scholarly journals The Role of Bone Scintigraphy with SPECT/CT in the Characterization and Early Diagnosis of Stage 0 Charcot Neuroarthropathy

2020 ◽  
Vol 9 (12) ◽  
pp. 4123
Author(s):  
Raju Ahluwalia ◽  
Ahmad Bilal ◽  
Nina Petrova ◽  
Krishna Boddhu ◽  
Chris Manu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Early Diagnosis ◽  
Bone Scintigraphy ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Charcot Foot ◽  
Bone Pathology ◽  
Charcot Neuroarthropathy ◽  
Focal Uptake ◽  
Stage 1

We describe the use of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in the investigation and diagnosis of Charcot neuroarthropathy (CN) in patients with a hot swollen foot but normal radiographs and clinical suspicion of CN, usually termed Stage 0. This was a retrospective cohort review of 46 diabetes patients who underwent 3 phase bone scintigraphy with “High Resolution” SPECT/CT. The imaging demonstrated that Stage 0 Charcot foot has a distinct bone pathology, which can be classified into three groups: (1) fractures on Computed Tomography (CT) with accompanying focal uptake of tracer on SPECT, (2) bony abnormalities apart from fracture on CT with focal uptake of tracer on SPECT, and (3) normal CT but focal bony uptake of tracer on SPECT. The CT component of SPECT/CT detected bony fractures in 59% of patients. Early treatment with below knee cast and follow-up for 24 months showed only 4 patients who developed Stage 1 Eichenholtz Charcot foot. Our findings support the use of 3 phase bone scintigraphy with SPECT/CT in the characterization and early diagnosis of CN. Stage 0 Charcot foot has a distinct bone pathology which requires urgent treatment to prevent progression to Stage 1 Eichenholtz Charcot foot. If SPECT/CT is unavailable, CT alone will detect bone fracture in 59% patients.

IRIDOCYCLITIS IN JUVENILE RHEUMATOID ARTHRITIS

PEDIATRICS ◽  
1969 ◽  
Vol 44 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Jane Schaller ◽  
Carl Kupfer ◽  
Ralph J. Wedgwood
Keyword(s):  
Rheumatoid Arthritis ◽  
Juvenile Rheumatoid Arthritis ◽  
Signs And Symptoms ◽  
Joint Disease ◽  
Slit Lamp ◽  
Patients At Risk ◽  
Eye Involvement ◽  
Eye Examination ◽  
Systemic Manifestations ◽  
Polyarticular Disease

Eight of 70 children with juvenile rheumatoid arthritis have developed iridocyclitis. This complication occurred more frequently in patients with monoarticular and pauciarticular disease (29%) than in patients with polyarticular disease (2%). Seven of eight patients with iridocyclitis have monoarticular or pauciarticular disease; none has had prominent systemic manifestations or evidence of ankylosing spondylitis. Iridocyclitis preceded joint manifestations in two of the patients and followed arthritis by 1 to 10 years in six of the patients. Activity of iridocyclitis and arthritis seemed unrelated; four patients developed iridocyclitis while arthritis was inactive. In seven children iridocyclitis began insidiously without acute symptoms. Eye involvement has remained unilateral in six patients. Six children have had significant decrease in visual acuity, and six continue to have active ocular inflammation despite therapy. Iridocyclitis is potentially a major cause of disability in juvenile rheumatoid arthritis. Early signs and symptoms may be minimal. Patients at risk are those with limited forms of joint disease. Early detection and therapy are crucial for prevention of permanent ocular damage. Careful eye examination should be a routine part of physical examination of children with rheumatoid arthritis, and periodic slit lamp examinations should be performed even when arthritis is in remission.

Four common diseases causing sudden blindness or death in the eye emergency department

2020 ◽  
pp. postgradmedj-2020-138163
Author(s):  
Ana Leonor Rei da Cruz Escaleira ◽  
Dimitrios Kalogeropoulos ◽  
Chris Kalogeropoulos ◽  
Soon Wai Ch’Ng ◽  
Velota C T Sung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Delayed Diagnosis ◽  
Signs And Symptoms ◽  
Ocular Motility ◽  
Ocular Manifestations ◽  
Ischaemic Attack ◽  
High Index Of Suspicion ◽  
Sudden Blindness ◽  
Patient At Risk ◽  
Prompt Diagnosis

Neuro-ophthalmological emergency disorders typically present with symptoms of visual loss, diplopia, ocular motility impairment or anisocoria. The ocular manifestations of these disorders are sometimes indicative of a more serious global neurology disease rather than an isolated ocular disease. The aim of this review is to highlight four important neuro-ophthalmological emergency disorders that must not be missed by an ophthalmologist. These include acute painful Horner’s syndrome, painful cranial nerve III palsy, giant cell arteritis and transient ischaemic attack with amaurosis fugax. The delayed diagnosis of these clinical entities puts the patient at risk of blindness or death. Therefore, prompt diagnosis and management of these conditions are essential. This can be acquired from understanding the main signs and symptoms of the disease presentation together with a high index of suspicion while working at a busy eye emergency department.

Charcot Neuroarthropathy of the Foot and Ankle

2016 ◽  
Vol 34 (3) ◽  
pp. 135-139 ◽  
Author(s):  
Lisa K. Burson ◽  
Christopher H. Schank
Keyword(s):  
Foot And Ankle ◽  
Charcot Neuroarthropathy

Delayed Tuberculosis Diagnosis in a Low Incidence Country and its Effect on Cost of Care

2021 ◽  
Author(s):  
James O'Connell ◽  
Niamh Reidy ◽  
Cora McNally ◽  
Debbi Stanistreet ◽  
Eoghan de Barra ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Care Provider ◽  
Delayed Diagnosis ◽  
Signs And Symptoms ◽  
Cost Of Care ◽  
Global Priority ◽  
Low Incidence ◽  
The Cost ◽  
Health Care Records

Abstract Background Tuberculosis elimination (TB) is a global priority that requires high-quality timely care to be achieved. In low TB incidence countries such as Ireland, delayed diagnosis is common. Despite cost being central to policy making, it is not known if delayed care affects care cost among TB patients in a low-incidence setting. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1st 2018 and December 31st 2019 were reviewed to measure and determine predictors of patient-related delays, health care-provider related delay and the cost of TB care. Benchmarks against which the outcomes were compared were derived from the literature. Results Thirty-seven patients were diagnosed with TB and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider-related delay among patients with PTB was 16 days and, although similar to the benchmark (median 22 days, minimum 11 days, maximum 36 days) could be improved. The health care-provider related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298, and while similar to that reported in the literature (median €9,319, minimum €6,486, maximum €14,750) could be improved. Patient-related delay among those with PTB predicted care costs. Conclusion Patient-related and health care-related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.

Crohn Disease in Childhood and Adolescence

2018 ◽  
Author(s):  
Lori Zimmerman
Keyword(s):  
Weight Loss ◽  
Gastrointestinal Tract ◽  
Crohn Disease ◽  
Signs And Symptoms ◽  
Mucosal Healing ◽  
Joint Disease ◽  
Perianal Disease ◽  
Childhood And Adolescence ◽  
Chronic Inflammatory Condition ◽  
And Behavior

Crohn disease (CD) is a chronic inflammatory condition that can occur throughout the gastrointestinal tract (the mouth to the anus). CD is classified by location within the gastrointestinal tract and behavior of the disease (inflammatory, penetrating, and/or stricturing). It can also affect the extraintestinal tissue and cause perianal disease. It occurs from a complex interplay of genetic predisposition, altered gut microbiota, immunologic dysregulation, and likely environmental triggers. Children with CD often present with signs and symptoms related to the inflammation within their gastrointestinal tract. Most children with CD will present with diarrhea and abdominal pain, whereas some will present with rectal bleeding, fevers, weight loss, perianal disease, or joint disease. There is no single test to confidently diagnose a patient with CD. Instead, clinicians rely on a combination of biomarkers in the serum and stool, imaging studies, and endoscopic evaluation to make the diagnosis. The general aims of treatment of children with CD are to induce and maintain clinical remission of disease, optimize nutrition and growth, minimize adverse effects of therapies, and ultimately target mucosal healing. This review contains 3 figures, 3 tables and 34 references. Key Words: biologics, child, chronic diarrhea, Crohn disease, hematochezia, inflammatory bowel disease, immunodeficiency, pediatric, weight loss

Crohn Disease in Childhood and Adolescence

2018 ◽  
Author(s):  
Lori Zimmerman
Keyword(s):  
Weight Loss ◽  
Gastrointestinal Tract ◽  
Crohn Disease ◽  
Signs And Symptoms ◽  
Mucosal Healing ◽  
Joint Disease ◽  
Perianal Disease ◽  
Childhood And Adolescence ◽  
Chronic Inflammatory Condition ◽  
And Behavior

Crohn disease (CD) is a chronic inflammatory condition that can occur throughout the gastrointestinal tract (the mouth to the anus). CD is classified by location within the gastrointestinal tract and behavior of the disease (inflammatory, penetrating, and/or stricturing). It can also affect the extraintestinal tissue and cause perianal disease. It occurs from a complex interplay of genetic predisposition, altered gut microbiota, immunologic dysregulation, and likely environmental triggers. Children with CD often present with signs and symptoms related to the inflammation within their gastrointestinal tract. Most children with CD will present with diarrhea and abdominal pain, whereas some will present with rectal bleeding, fevers, weight loss, perianal disease, or joint disease. There is no single test to confidently diagnose a patient with CD. Instead, clinicians rely on a combination of biomarkers in the serum and stool, imaging studies, and endoscopic evaluation to make the diagnosis. The general aims of treatment of children with CD are to induce and maintain clinical remission of disease, optimize nutrition and growth, minimize adverse effects of therapies, and ultimately target mucosal healing. This review contains 3 figures, 3 tables and 34 references. Key Words: biologics, child, chronic diarrhea, Crohn disease, hematochezia, inflammatory bowel disease, immunodeficiency, pediatric, weight loss

Charcot Arthropathy of the Diabetic Foot. Current Concepts and Review of 36 Cases

2002 ◽  
Vol 91 (2) ◽  
pp. 195-201 ◽  
Author(s):  
T.-K. Pakarinen ◽  
H.-J. Laine ◽  
S. E. Honkonen ◽  
J. Peltonen ◽  
H. Oksala ◽  
...  
Keyword(s):  
Recent Literature ◽  
Diagnostic Delay ◽  
Patient Records ◽  
Charcot Foot ◽  
Charcot Arthropathy ◽  
Triple Arthrodesis ◽  
Charcot Neuroarthropathy ◽  
Cast Immobilisation ◽  
Tibiocalcaneal Arthrodesis ◽  
Time Period

Background and Aims: The incidence of diabetic Charcot neuroarthropathy has increased. The purpose here was to study the current diagnostics and treatment of the Charcot foot. Materials and Methods: During a time period from 1994 to 2000, a total of 36 feet were diagnosed as cases of diabetic Charcot neuroarthropathies. A retrospective analysis of patient records and radiographs was undertaken. A review of the recent literature is presented. Results: 29 cases were diagnosed in the dissolution stage, 2 in coalascence, and 5 in the resolution stage. The diagnostic delay averaged 29 weeks. Treatment with cast immobilisation ranged from 4 to 37 weeks (mean 11 weeks). A total of 14 surgical procedures were carried out on 10 patients: six exostectomies, four midfoot arthrodeses, one triple arthrodesis, one tibiocalcaneal arthrodesis and two below-knee amputations. radiological fusion was achieved in two thirds of the attempted arthrodeses. Conclusions: A physician should always consider the Charcot neuroarthropathy when a diabetic patient has an inflamed foot. In the absence of fever, elevated CRP or ESR, infection is a highly unlikely diagnosis, and a Charcot process should primarily be considered. The initial treatment of an inflamed Charcot foot consists in sufficiently long non-weightbearing with a cast, which should start immediately after the diagnosis. The prerequisites of successful reconstructive surgery are correct timing, adequate fixation and a long postoperative non-weightbearing period. In the resolution stage most Charcot foot patients need custom-molded footwear.

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