Benchmark analysis of diabetic patients with neuropathic (Charcot) foot deformity

During a 10-year period, 237 patients (129 women, 108 men) with a diagnosis of neuropathic (Charcot) arthropathy of the foot and ankle were treated in a tertiary care university hospital medical center. During this period, 11 5 of the patients (48.5%) were treated nonoperatively as outpatients with l ocal skin and nail care, accommodative shoe wear, and custom foot orthoses. A total of 120 (50.6%) underwent 143 operations. Surgery included 21 major limb amputations, 29 ankle fusions, 26 hindfoot fusions, 23 exostectomies, and 23 debridements for osteomyelitis. It is widely accepted that patients with diabetes are at risk for developin g foot ulcers, which can lead to lower extremity amputation. Within the pop ulation of diabetic patients, it is widely accepted that patients with neur opathic (Charcot) arthropathy of the foot and ankle have one of the highest likelihoods of having to undergo lower extremity amputation. The current e mphasis in care of the foot of a diabetic patient involves a multidisciplin ary team approach combining patient education, skin and nail care, and acco mmodative shoe wear. As data from prophylactic programs become available, r esource allocation and cost of care can be compared with this benchmark bas eline. This benchmark analysis can be used by those who are responsible for alloca ting resources and projecting healthcare costs for this "high utilization"/ high risk patient population.