The consequences of complacency: managing the effects of unrecognized Charcot feet

• Published in: Diabetic medicine 2011-02, Vol.28 (2), p.195-198
• Main Authors: Wukich, D. K., Sung, W., Wipf, S. A. M., Armstrong, D. G.
• Format: Article
• Language: English
• Subjects: Amputation; Arthropathy, Neurogenic - diagnostic imaging; Arthropathy, Neurogenic - physiopathology; Arthropathy, Neurogenic - therapy; Associated diseases and complications; Attitude to Health; Biological and medical sciences; charcot; diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - diagnostic imaging; Diabetic Neuropathies - physiopathology; Diabetic Neuropathies - therapy; Early Diagnosis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Feeding. Feeding behavior; Female; foot; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Middle Aged; Radiography; Retrospective Studies; surgery; Treatment Outcome; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2010.03141.x

Diabet. Med. 28, 195–198 (2011) Aims  Several authors have discussed an early prodromal state of neuroarthropathy (stage 0 Charcot) prior to the development of frank radiographic changes. However, very few reports are available that detail the outcomes of these patients. The purpose of this study was to report on the outcomes of patients with undetected early Charcot neuroarthropathy of the foot. Methods  Twenty patients, from two health science centres, were diagnosed retrospectively with stage 0 Charcot neuroarthropathy and were managed after referral from outside facilities. We evaluated any complications, including ulcer formation, infection, progression into active Charcot neuroarthropathy and the need for surgical reconstruction. Patients who did not progress to an active Charcot neuroarthropathy (Group I) were compared with those (Group II) who did progress to the destructive phase. Results  The diagnosis of Charcot neuroarthropathy was missed in 19 of 20 patients prior to referral. The average delay in treatment in Group I was 4.1 ± 0.7 weeks compared with 8.7 ± 6.8 weeks in Group II (Mann–Whitney U‐test = 24.5, n1 = 15, n2 = 7, P