Abstract
The management of acute Charcot neuroarthropathy relies on off-loading which is costly and time-consuming. Published studies have used monitoring techniques with unknown diagnostic precision to detect remission. We performed a systematic review of techniques for monitoring response to offloading in acute Charcot neuroarthropathy. We included studies of off-loading which evaluated or described monitoring techniques in acute Charcot neuroarthropathy. PubMed, EMBASE, CINAHL and Cochrane databases were searched (January1993-July 2018). We extracted data from papers including study design, setting, population, monitoring techniques and treatment outcomes. We also extracted information on the cost, clinical applicability, sensitivity and specificity, safety and participant acceptability of the monitoring techniques. We screened 1205 titles, 140 abstracts and 45 full-texts, and included 29 studies. All studies were of low quality and at high risk of bias. In seven studies, the primary aim was to evaluate monitoring techniques: three evaluated magnetic resonance imaging, two thermography monitoring, one three-phase bone scanning and one Doppler spectrum analysis. The remaining 22 observational studies reported treatment outcomes and described the monitoring techniques used to assess the Charcot neuroarthropathy. Heterogeneity prevented the pooling of data. Very few studies included data on cost, clinical applicability, sensitivity and specificity, safety and patient acceptability of the monitoring techniques used. Multiple techniques have been used to evaluate remission in acute Charcot neuroathropathy but uncertainty remains about their effectiveness. We recommend further research into the influences of different monitoring techniques on treatment outcomes.
Highlights
IntroductionCharcot neuroarthropathy (CN) is a complication of peripheral neuropathy associated with diabetes which affects the lower limb
Multiple techniques have been used to evaluate remission in acute Charcot neuroarthropathy (CN) but uncertainty remains about their effectiveness
Charcot neuroarthropathy (CN) is a complication of peripheral neuropathy associated with diabetes which affects the lower limb
Summary
Charcot neuroarthropathy (CN) is a complication of peripheral neuropathy associated with diabetes which affects the lower limb. It may be precipitated by minor trauma or other inflammatory insult which the patient does not notice due to insensitivity to pain. The symptoms include redness, warmth and swelling in the foot and/or leg. It can cause fractures and dislocations within the foot, which may progress to deformity and ulceration. Treatment for CN is ‘off-loading’ the application of a non-removable plaster or fibreglass cast or boot; this rests and immobilises the foot and redistributes the weight and pressure from the foot to the leg 3. Off-loading is continued until remission when there are no longer clinical signs of inflammation, and X-rays are stable with signs of healing 2
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
