Current practice patterns in the treatment of Charcot foot

Treatment of Charcot foot osteoarthropathy has emerged as a major component of the American Orthopaedic Foot and Ankle Society (AOFAS) Diabetes 2000 I nitiative. A two-part survey described treatment patterns and current footw ear use of patients with Charcot osteoarthropathy of the foot and ankle. In the first part, 94 consecutive patients with a history of Charcot foot and ankle presenting for care were questioned on their foot-specific treatment and current footwear use. A history of diabetic foot ulcer was given by 39 (41%) patients, and an infection had been present in a foot of 20 (21%) pa tients. The initial treatment of the Charcot foot and ankle had been a tota l contact cast in 46 (49%) patients, and a pre-fabricated walking boot in 1 9 (20%). Charcot related surgery had consisted of 76 procedures in 46 (49%) patients. Sixty-three (67%) patients were currently using accommodative fo otwear (depth-inlay shoes in 46 [49%], custom shoes in 10 [11%], and CROW i n 7 [7%] patients), and 72 (77%) were currently using custom accommodative foot orthoses. The second part of this study consisted of a questionnaire completed by 37 orthopaedic surgeons (members of AOFAS) interested in forming a Charcot Stu dy Group. They treated an average of 11.8 patients having Charcot foot or a nkle per month. Thirty (81%) used the Semmes-Weinstein 5.07 monofilament as a screening tool for peripheral neuropathy. For treatment of Eichenholtz S tage 1, 29 (78%) used a total contact cast and 15 (41%) allowed weightbeari ng; for Stage 11, 30 (81%) physicians used a total contact cast and 18 (49% ) allowed weight-bearing. Although the literature contains uniform recommendations for immobilization and non-weightbearing as treatment for the initial phases of Charcot arthr opathy, the results of this benchmarking study reveal that current treatmen t is varied.