Aim and method We report the outcomes of 100 consecutive diabetic patients who had been prescribed diabetic footwear for 10 years. A podiatrist and orthotist reviewed them at a dedicated clinic. The study aim was to assess footwear efficacy and prevention of ulcers, re-ulceration and amputations.

Conclusion Protective footwear is essential in maintaining healthy diabetic feet. Amputations were only due to vascular complications. All 56 patients who attended remained intact at 2 years. Of the seven ulcerations at 5 years, three went onto below-knee amputation. At 10 years, there were a further three ulcerations, resulting in one minor black toe and one further BK amputation.

Adherence with follow up including footwear review minimises risk. Re-ulceration at 5 years is associated with risk of amputation. Ten-year mortality is high due to vascular complications.

Summary Continued patient adherence with Orthotic therapy confers benefit and minimised re-ulceration. Follow up by Orthotists is an under-utilised resource.

Charcot neuroarthropathy is a progressive, destructive process occurring in the presence of neuropathy. We report the outcome of neuropathic foot joints presenting to our clinic over a 12 year period.

Methods

Cases were identified from the Diabetic Foot Clinic Register, 1989–2001. We studied patient demographics, clinical presentation, distribution, treatment and outcome.

Results

Twenty-eight episodes of arthropathy occurred in 23 patients. Age at onset ranged from 40 to 79 years. Presentation was acute in 14 and subacute in the others. Sites affected included 23 mid foot, 4 ankle and 1 MTP. Nine feet were ulcerated at presentation, eight had a history of ulcer, nine have no ulcer history. Infection complicated the Charcot process in 15. Mean Hba1c at presentation was 9.3%.

Treatments

Total contact casting 23, 4 “scotch cast” boots and 1 Air-cast walker. Pamidronate was given to 10 patients.

Outcomes

Three patients died. Two had below knee amputations. Casts were required for up to 12 months. Three required orthopaedic foot reconstructions. All ulcers present initially healed.

Conclusion

Charcot arthropathy remains uncommon. In our series treatment was successful in all but two patients in terms of preserved limbs, mobility and freedom from ulceration.