Fractures and Osteoporosis in Patients With Diabetes With Charcot Foot

Diabetes Care ◽  
2021 ◽  
pp. dc210369
Author(s):  
Oliver Christian Rabe ◽  
Matilde Winther-Jensen ◽  
Kristine Højgaard Allin ◽  
Ole Lander Svendsen
Keyword(s):  
Charcot Foot ◽  
Patients With Diabetes

scholarly journals An unusual presentation of acute onset Charcot arthropathy

2020 ◽  
Vol 2020 (5) ◽  
Author(s):  
Ammar Al-Najjar ◽  
Julien Al Shakarchi ◽  
Melwyn Pereira ◽  
Richard Downing
Keyword(s):  
Rare Complication ◽  
Major Amputation ◽  
Acute Onset ◽  
Lower Limbs ◽  
Charcot Foot ◽  
Charcot Arthropathy ◽  
Plantar Aspect ◽  
Patients With Diabetes ◽  
Fracture Dislocations ◽  
High Index Of Suspicion

Abstract Charcot arthropathy is a progressive condition primarily affecting the lower limbs in patients with diabetes mellitus. It is a rare complication of diabetic neuropathy and if left untreated can lead to severe limb destruction necessitating major amputation. Here, we report the case of a 41-year-old female who presented with rapidly progressive Charcot foot over a 10-day period, necessitating open reduction and internal fixation of Lisfranc-type fracture dislocations. Her presentation with a rapidly progressing red, swollen foot with a blister on the plantar aspect prompted initial treatment on the basis of a diabetic foot infection. The report will therefore serve as a useful reminder to maintain a high index of suspicion for Charcot foot, which may present in an atypical manner.

scholarly journals How Common Is the Rare Charcot Foot in Patients With Diabetes?

Diabetes Care ◽  
2021 ◽  
pp. dc202590
Author(s):  
Ole Lander Svendsen ◽  
Oliver Christian Rabe ◽  
Matilde Winther-Jensen ◽  
Kristine Højgaard Allin
Keyword(s):  
Charcot Foot ◽  
Patients With Diabetes

Role of Dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus

2011 ◽  
Vol 40 (8) ◽  
pp. 991-999 ◽  
Author(s):  
Virna Zampa ◽  
Irene Bargellini ◽  
Loredana Rizzo ◽  
Francesca Turini ◽  
Simona Ortori ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Dynamic Mri ◽  
Charcot Foot ◽  
Patients With Diabetes

Risk Reduction and Perioperative Complications in Patients With Diabetes and Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction

2021 ◽  
pp. 107110072199542
Author(s):  
Madeline Lyons ◽  
Patrick Cole McGregor ◽  
Michael S. Pinzur ◽  
William Adams ◽  
Lynette Wilkos-Prostran
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Regional Anesthesia ◽  
Perioperative Complications ◽  
Perioperative Period ◽  
Risk Calculator ◽  
Charcot Foot ◽  
Medical Comorbidities ◽  
Acs Nsqip ◽  
Patients With Diabetes

Background: Modern patient safety programs focus on medical optimization of patients prior to surgery, regional anesthesia when possible, and hospitalist-orthopedic co-management during the perioperative period. Methods: Eighty-five consecutive patients with diabetes and multiple medical comorbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized risk reduction program that included medical optimization prior to surgery, regional anesthesia whenever possible, and hospitalist-orthopedic co-management during the perioperative period. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk. Results: On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (rate ratio [RR], 1.36; P = .01) and congestive heart failure (RR, 1.42; P = .02). There were 22 (26%) complications, though only 10 (12%) were serious. These included acute kidney injury ( n = 6), sepsis ( n = 2), 1 cardiac event, and 1 pulmonary embolism. Overall, the accuracy of predicting a complication using the ACS NSQIP Risk Calculator was 74% (95% CI, 63%-85%), which was comparable to the accuracy of predicting a complication using only patients’ congestive heart failure and pin-tract infection statuses ( c = 74%, 95% CI, 62%-86%). Discussion: Medical optimization of patients with diabetes and multiple medical comorbidities prior to elective complex reconstruction orthopedic surgery allows the surgery to be performed with a predictable risk for perioperative complications. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The ACS NSQIP Risk Calculator appears to be a reliable predictor of complications during the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to perioperative risk. Level of Evidence: Level IV, retrospective case series.

scholarly journals Charcot Foot, a Rare and Severe Complication of Diabetes Mellitus

2020 ◽  
Vol 25 (1) ◽  
pp. 32-35
Author(s):  
Alin Mihețiu ◽  
Ioana Matei ◽  
Alexandra Sandu ◽  
Elena Rizea ◽  
Sînziana Nicolae
Keyword(s):  
Diabetes Mellitus ◽  
Rare Disease ◽  
External Fixation ◽  
Acute Phase ◽  
Early Recognition ◽  
Severe Complication ◽  
Charcot Foot ◽  
Bone Damage ◽  
Patients With Diabetes ◽  
Charcot Neuropathy

AbstractCharcot foot or Charcot neuropathy is a rare disease found in patients with diabetes mellitus and is characterized by bone damage to the foot leading to deformities, instability, functional impotence and even amputation. The mechanism is still under discussion, without a consensus regarding the pathophysiology of this condition. The treatment is a complex one, non-surgical and surgical, the non-surgical one addressing especially the acute phase of the disease, the surgical one being complex and ranging from osteotomy, debridement, arthrodesis, internal or external fixation or even amputation. A good management of diabetes, of its peripheral complications, an early recognition of the Charcot type foot, prevents the evolution towards this serious condition.

scholarly journals Influence of Patient Setting and Dedicated Limb Salvage Efforts on Outcomes in Charcot-Related Foot Ulcer

2019 ◽  
Vol 18 (4) ◽  
pp. 362-366 ◽  
Author(s):  
Brian M. Schmidt ◽  
Crystal M. Holmes
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Patient Outcomes ◽  
Foot Ulcer ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Charcot Foot ◽  
Specialist Care ◽  
Charcot Neuroarthropathy ◽  
Patients With Diabetes

Charcot neuroarthropathy is a devastating consequence of diabetes mellitus and peripheral neuropathy. Because of its rarity, the condition is often misdiagnosed or poorly managed. When misadventure occurs, patients with Charcot neuroarthropathy can suffer ulceration, infection, amputation, and death. When patients have Charcot-related foot ulcers, the risks are amplified. Utilizing advanced electronic medical record analysis, a 30-month investigation was undertaken to determine if patients with diabetes mellitus and a concomitant diagnosis of Charcot-related foot ulcer were at greater risk of complications because of location setting of initial treatment for their condition. Charcot foot–related ulcers that are diagnosed in the outpatient setting had established foot specialist care. The outpatient management of the condition lead to a significant reduction in the amount of admissions to a higher acuity setting. However, patient outcomes did not vary once established and dedicated limb salvage efforts were employed. In this large contemporary population managed in a tertiary health system, patients with Charcot-related foot ulcer had negative outcomes when they were initially treated in an inpatient setting and had a significantly greater likelihood of readmission as compared with individuals who had established focused limb salvage care.

Prevalence and Associates of Foot Deformities among Patients with Diabetes in Jordan

2020 ◽  
Vol 16 (5) ◽  
pp. 471-482
Author(s):  
Anas Ababneh ◽  
Faris G. Bakri ◽  
Yousef Khader ◽  
Peter Lazzarini ◽  
Kamel Ajlouni
Keyword(s):  
Hallux Valgus ◽  
Sensory Neuropathy ◽  
Foot Deformities ◽  
Joint Mobility ◽  
Charcot Foot ◽  
Painful Neuropathy ◽  
Limited Joint Mobility ◽  
Pes Cavus ◽  
Hammer Toe ◽  
Patients With Diabetes

Objectives: To determine the prevalence of, and factors associated with, people with foot deformities, among patients with diabetes in Jordan. Methods: A cross-sectional study was conducted on 1000 diabetic participants recruited from the National Center for Diabetes, Endocrinology, and Genetics in Jordan. Participants had their feet clinically examined to detect the following foot deformity outcomes: Hallux valgus, claw/hammer toe, prominent metatarsal heads, limited joint mobility, pes cavus, Charcot foot, and amputations. Sociodemographic and health variables were also collected from participants’ interviews, medical records, or clinical examination. Logistic regression was used to analyse associations between variables and each foot deformity outcome. Results: Of the 1000 diabetic patients: Hallux valgus was found in 17.4%, claw\hammer toe in 16%, prominent metatarsal head in 14.2%, limited joint mobility in 9.4%, pes cavus in 3.2%, Charcot foot in 2.1%, and amputations in 1.7%. Hallux valgus was associated with gender (p=0.012), age (p<0.01) and shoe choices (p=0.031); claw\hammer toe was associated with age (p=0.04), retinopathy (p<0.001), sensory and painful neuropathy (p<0.001); limited joint mobility was associated with age only (p=0.001); Charcot foot was associated with glycemic control (p=0.016), hypertension (p<0.000), sensory neuropathy (p<0.001), and painful neuropathy (p<0.001); and, amputations were associated with duration of diabetes (p<0.043), sensory neuropathy (p=0.001), and painful neuropathy (p=0.001). Conclusion: Prevalence of different foot deformities in Jordan variedbetween 1.7% - 17.4%. Sociodemographic factors such as age, gender and shoes choices or presence of diabetes-related microvascular complications (neuropathy and retinopathy) or hypertension were independently associated with foot deformities among the Jordanian diabetic population.

Foot Shape and Asymmetry in the Charcot Foot: Assessment Using the Foot Posture Index

2020 ◽  
Vol 110 (1) ◽  
Author(s):  
Joshua Young
Keyword(s):  
Comparison Group ◽  
Outcome Measurement ◽  
Absolute Difference ◽  
Fisher Exact Test ◽  
Charcot Foot ◽  
Normal Range ◽  
Foot Posture Index ◽  
Posture Index ◽  
Patients With Diabetes ◽  
Foot Posture

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.

scholarly journals Charcot foot (neuropathic arthropathy) in diabetes as a "special needs foot". Case report of an efficient negative pressure wound therapy use.

2018 ◽  
Vol 5 (1) ◽  
Author(s):  
Bartosz Cybułka
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Multiple Organ ◽  
Autonomic Nerves ◽  
Charcot Foot ◽  
Orthopedic Treatment ◽  
Neuropathic Arthropathy ◽  
Optimal Care ◽  
Irreversible Damage ◽  
Patients With Diabetes

Diabetes is the most common endocrine disorder of carbohydrate metabolism. If left untreated, or improperly treated for many years, diabetes leads to multiple organ complications. One of the serious consequences of the disease is damage to the peripheral and autonomic nerves known as diabetic neuropathy. The most advanced form of neuropathy, leading to damage to the structures of the forefoot, midfoot and hindfoot, is the so called Charcot foot, or neuropathic osteoarthropathy. Irreversible damage to the structures of the foot affects between 0,1% and 7.5% of patients with diabetes. The optimal care for that form of foot damage is still a subject to debate. Available methods of caring for Charcot foot include invasive orthopedic treatment and conservative treatment. The use of negative pressure woudn therapy may be an effective, as well as transitional, way of managing Charcot foot.  

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