Recognition and management of acute neuropathic (Charcot) arthropathies ofthe foot and ankle

Study Design: Review of selected literature describing the outcomes related to the management of acute Charcot foot arthropathies in patients with dia betes mellitus. Objective: To familiarize the rehabilitation specialist with the general pr inciples of nonsurgical management for patients with acute neuropathic arth ropathies of the foot and ankle. Background: Neuropathic (Charcot) arthropathy of the foot or ankle is the m ost destructive and disabling chronic complication of all diabetic loot dis ease. Methods and Measures: We discuss the clinical presentation and the role tha t orthopaedic and sports physical therapists may have in identifying and pr eventing complications and the long-term disability associated with these a rthropathies. We summarize the outcomes of 15 published reports from 1985-1 999 located using the MEDLINE database from 1966-present. Studies were sele cted and included ii the authors reported on (1) 2 or more patients with di abetes mellitus and acute Charcot arthropathies; (2) the short-term or long -term outcomes, including the length of follow-up; and (3) the pattern or l ocation of the arthropathy. The short-term outcomes (percentage of patients healed, average time to healing) and long-term outcomes (percentage in who m treatment failed, amputation, disability) after treatment by immobilizati on alone or immobilization after surgery were reviewed and summarized. Results: The prognosis for an individual with severe neuropathic skeletal f oot deformities is poor. Eleven deaths (3.65%) in 301 patients were reporte d within the average follow-up period of 2.5 years after treatment for Char cot arthropathy. Partial or complete foot amputation occurred in 20 (6.6%) of 301, whereas 83 (28%) of 301 patients reviewed had mobility limitations or required ankle-foot orthoses or permanent bracing or assistive devices f or ambulation at the time of follow-up. Conclusion: Rehabilitation specialists can improve the short-term outcomes and limit the long-term disabilities in patients with diabetes mellitus and peripheral neuropathy. Early recognition and prompt immobilization are the basic principles of nonsurgical management that influence therapeutic outc ome.