Abstract
Aim: Evaluation of multifactorial treatment of Charcot foot disease in diabetic patients
Materials and Method: We followed 25 diabetic patients with Charcot foot in acute phase (Eichenholtz Stage I) from 2001 to 2003 (mean follow-up 22 months) admitted to the Day Hospital of Diabetology of the Catholic University of Rome. All patients presented a good vascularization (ABI > 0.9) and osteomielytis was excluded by means of 111Indium labelled leukocyte scintigraphy.
Six patients presented a structural derangement localized to the forefoot (Pattern I according to Sanders and Frykberg Classification), one to the ankle (Pattern IV) and 18 to the mid-foot region (Pattern II and III). At first clinical evaluation, 13 patients presented a plantar monolateral ulcer. Their treatment was multifactorial. An offloading regimen was adopted, with the use of a total contact cast and crutches, in order to avoid weight-bearing on the affected foot for the first two months. Patients responsive to the treatment were successively treated with a pneumatic cast (Air cast) and partial weight-bearing for another four months. Four unresponsive patients underwent surgical treatment. 10 patients were also treated with alendronate (70 mg per os once a week). Three patients died during treatment and one during the follow-up, three of them for cardiovascular disease, one for bronchopneumopathy.
Results: All patients reached the quiescent or chronic phase (Eichenholtz Stage III) at an average of six months from the onset of the treatment (range 3 to 9 months). No major or minor amputation was performed. Multifactorial treatment prevented the development ulcers in all patients that started the treatment without this complication (12 patients). 7 out of 13 ulcerated patients developed a recalcitrant ulcer (unresponsive to medical and orthotic treatment). 4 patients underwent surgical treatment: midfoot arthrodesis with Ilizarov external fixation (2 patients), rockerbottom deformity resection (one patient), Lelievre realignment (one patient). 3 patients healed after surgical treatment. Thus an overall amount of 9 out of 13 ulcerated patients healed after multifactorial treatment.
Conclusions: Multifactorial treatment demonstrated effective in the management of Charcot foot in diabetic patients. Medical and orthotic treatment alone is effective in preventing complication throughout the natural history of the disease. Medical and orthotic treatment alone is frequently unsuccessful in treating plantar ulcers when major deformities has already developed. Medical and orthotic treatment combined with surgical treatment demonstrated an increased percentage of success.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
