THE NATURAL-HISTORY OF ACUTE CHARCOTS ARTHROPATHY IN A DIABETIC FOOT SPECIALTY CLINIC

The aim of this longitudinal study was to report on the clinical chara cteristics and treatment course of acute Charcot's arthropathy at a te rtiary care diabetic foot clinic. Fifty-five diabetic subjects, with a mean age of 58.6 +/- 8.5 years, were studied. All patients were treat ed with serial total contact casting until quiescence. Following casti ng and before transfer to prescription footwear, patients were eased i nto unprotected weightbearing via a removable cast walker. This cohort was followed for their entire treatment course and for a mean 92.6 +/ - 33.7 weeks following return to shoes. Pain was the most frequent pre senting complaint in these otherwise insensate patients (76 %). The me an duration of casting was 18.5 +/- 10.6 weeks. Patients returned to f ootwear in a mean 28.3 +/- 14.5 weeks. Nine per cent of the population had bilateral arthropathy. These subjects were casted significantly l onger than the unilateral group (p < 0.02). Surgery was performed on 2 5 % of patients, with approximately two-thirds of these procedures inv olving plantar exostectomies and one-third fusions of affected joints. Patients receiving surgery remained casted significantly longer than non-surgical patients (p < 0.05). Additionally, men were casted longer than women (p < 0.008). Acute Charcot's arthropathy requires prompt, uncompromising reduction in weightbearing stress. Our data show that t he ambulatory total contact cast is very effective for this. Regardles s of the specific treatment method instituted, it is imperative that a ppropriate and aggressive treatment be undertaken immediately followin g diagnosis to help prevent progression to a profoundly debilitating, limb-threatening deformity. (C) 1997 by John Wiley & Sons, Ltd.