• 1

    Rogers LC, Frykberg RG, Armstrong DG, et al: The Charcot foot in diabetes. Diabetes Care 34: 2123, 2011.

  • 2

    Wukich DK, Sung W: Charcot arthropathy of the foot and ankle: modern concepts and management review. J Diabetes Complications 23: 409, 2009.

  • 3

    Sanders L, Frykberg R: “The Charcot Foot (Pied de Charcot),” in Levin and O'Neal's the Diabetic Foot, 7th Ed, edited by JH Bowker, MA Pfeifer, p 257, Mosby Elsevier, Philadelphia, 2007.

    • Search Google Scholar
    • Export Citation
  • 4

    Boulton AJ, Jeffcoate WJ, Jones TL, et al: International collaborative research on Charcot's disease. Lancet 373: 105, 2009.

  • 5

    Saltzman CL, Hagy ML, Zimmerman B, et al: How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet? Clin Orthop Relat Res 435: 185, 2005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Wild S, Roglic G, Green A, et al: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27: 1047, 2004.

  • 7

    Yu GV, Hudson JR: Evaluation and treatment of stage 0 Charcot's neuroarthropathy of the foot and ankle. JAPMA 92: 210, 2002.

  • 8

    Frykberg RG, Zgonis T, Armstrong DG, et al: Diabetic foot disorders: a clinical practice guideline (2006 revision). J Foot Ankle Surg 45 (suppl): S1, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Sohn MW, Stuck RM, Pinzur M, et al: Lower-extremity amputation risk after Charcot arthropathy and diabetic foot ulcer. Diabetes Care 33: 98, 2010.

  • 10

    Eichenholtz SN: Charcot Joints, p 3, Charles C Thomas, Springfield, IL, 1966.

  • 11

    Chantelau E: The perils of procrastination: effects of early vs. delayed detection and treatment of incipient Charcot fracture. Diabet Med 22: 1707, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Feng Y, Schlosser FJ, Sumpio BE: The Semmes Weinstein monofilament examination as a screening tool for diabetic peripheral neuropathy. J Vasc Surg 50: 675, 2009.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Lee S, Kim H, Choi S, et al: Clinical usefulness of the two-site Semmes-Weinstein monofilament test for detecting diabetic peripheral neuropathy. J Korean Med Sci 18: 103, 2003.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    McDermott MM, Sufit R, Nishida T, et al: Lower extremity nerve function in patients with lower extremity ischemia. Arch Intern Med 166: 1986, 2006.

  • 15

    Fontaine R, Kim M, Kieny R: Surgical treatment of peripheral circulation disorders. Helv Chir Acta 21: 499, 1954.

  • 16

    Bennell KL, Talbot RC, Wajswelner H, et al: Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother 44: 175, 1998.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Cleland J: Exploración Clínica en Ortopedia, un Enfoque para Fisioterapeutas Basado en la Evidencia, Masson, Barcelona, 2006.

  • 18

    Sobel E, Levitz SJ, Caselli MA, et al: Reevaluation of the relaxed calcaneal stance position: reliability and normal values in children and adults. JAPMA 89: 258, 1999.

    • Search Google Scholar
    • Export Citation
  • 19

    Keenan AM, Redmond AC, Horton M, et al: The Foot Posture Index: Rasch analysis of a novel, foot-specific outcome measure. Arch Phys Med Rehabil 88: 88, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Paton J, Jones RB, Stenhouse E, et al: The physical characteristics of materials used in the manufacture of orthoses for patients with diabetes. Foot Ankle Int 28: 1057, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Dahmen R, Haspels R, Koomen B, et al: Therapeutic footwear for the neuropathic foot: an algorithm. Diabetes Care 24: 705, 2001.

  • 22

    Brown D, Wertsch JJ, Harris GF, et al: Effect of rocker soles on plantar pressures. Arch Phys Med Rehabil 85: 81, 2004.

  • 23

    Fuller E, Schroeder S, Edwards J: Reduction of peak pressure on the forefoot with a rigid rocker-bottom postoperative shoe. JAPMA 91: 501, 2001.

    • Search Google Scholar
    • Export Citation
  • 24

    Gouveri E, Papanas N: Charcot osteoarthropathy in diabetes: a brief review with an emphasis on clinical practice. World J Diabetes 2: 59, 2011.

  • 25

    Cofield RH, Morrison MJ, Beabout JW: Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change. Foot Ankle 4: 15, 1983.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Trepman E, Nihal A, Pinzur MS: Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int 26: 46, 2005.

  • 27

    Armstrong DG, Todd WF, Lavery LA, et al: The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic. JAPMA 87: 272, 1997.

    • Search Google Scholar
    • Export Citation
  • 28

    Griffith J, Davies AM, Close CF, et al: Organized chaos? computed tomographic evaluation of the neuropathic diabetic foot. Br J Radiol 68: 27, 1995.

  • 29

    Rajbhandari SM, Jenkins RC, Davies C, et al: Charcot neuroarthropathy in diabetes mellitus. Diabetologia 45: 1085, 2002.

  • 30

    Pakarinen TK, Laine HJ, Maenpaa H, et al: Long-term outcome and quality of life in patients with Charcot foot. Foot Ankle Surg 15: 187, 2009.

  • 31

    van der Ven A, Chapman CB, Bowker JH: Charcot neuroarthropathy of the foot and ankle. J Am Acad Orthop Surg 17: 562, 2009.

  • 32

    Petrova NL, Edmonds ME: Charcot neuro-osteoarthropathy-current standards. Diabetes Metab Res Rev 24 (suppl 1): S58, 2008.

  • 33

    Pinzur M: Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int 25: 545, 2004.

Personalized Orthoses as a Good Treatment Option for Charcot Neuro-osteoarthropathy of the Foot

Maria Luz González Fernández Universidad Complutense de Madrid, Madrid, Spain.

Search for other papers by Maria Luz González Fernández in
Current site
Google Scholar
PubMed
Close
 PhD
,
Rosario Morales Lozano Universidad Complutense de Madrid, Madrid, Spain.

Search for other papers by Rosario Morales Lozano in
Current site
Google Scholar
PubMed
Close
 PhD
,
Carmen Martínez Rincón Universidad Complutense de Madrid, Madrid, Spain.

Search for other papers by Carmen Martínez Rincón in
Current site
Google Scholar
PubMed
Close
 PhD
, and
David Martínez Hernández Universidad Complutense de Madrid, Madrid, Spain.

Search for other papers by David Martínez Hernández in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Background

We sought to assess the biomechanical characteristics of the feet of patients with Charcot neuro-osteoarthropathy and to determine reulceration rates before and after personalized conservative orthotic treatment.

Methods

A longitudinal prospective study was performed in 35 patients with Charcot's foot. Although some patients had a history of ulcers, at the study outset no patient had ulcers. All of the patients underwent biomechanical testing and a radiographic study. A radiophotopodogram was prepared by superimposing an imprint of the sole on a plantar radiograph. Based on the results of these tests, an orthopedic insole was prepared and therapeutic footwear prescribed for each foot. The following variables were compared between the Charcot and unaffected feet: previous ulcers and ulcer sites, reulcerations produced after treatment, type of foot (neuropathic/neuroischemic), ankle mobility, first-ray mobility, and relaxed calcaneal stance position. Treatment efficacy was determined by comparing ulcers presenting in patients in the year leading up to the study period and the year in which treatment was received.

Results

In a 1-year period, 70 feet received orthotic treatment, of which 41 were Charcot's feet. Ulceration rates before the study were 73.2% in feet with Charcot's and 31.0% in those without. After 1 year of wearing the customized orthoses, rates fell significantly to 9.8% in the Charcot feet and 0% in the feet without this condition.

Conclusions

Conservative customized orthotic treatment was effective at preventing ulcers and the complications that often lead these patients to surgery.

Corresponding author: Maria Luz González Fernández, PhD, Universidad Complutense Madrid, Avda Complutense s/n, Madrid, 28240, Spain. (E-mail: luzalez@enf.ucm.es)