The Diabetic Charcot Foot – New Insights on Treatment

Abstract

The association between Charcot neuroarthropathy (CN) and diabetes mellitus was first described by Jordan in 1936 (Jordan WR, 1936). Since that time numerous treatment protocols have been proposed for this potentially devastating condition. Early diagnosis and swift care are the keys to reducing amputation risk in this patient population. Conservative management remains efficacious for certain clinical scenarios. Treatment of the patient should take into account the stage of CN, site(s) of involvement, presence or absence of ulceration, presence or absence of infection, overall medical status, and level of compliance. The most commonly used classification is the three-staged system described by Eichenholtz: Stage I is the developmental or acute phase, Stage II is the coalescent or quiescent phase, and Stage III is the consolidation or reconstruction and reconstitution phase (Eichenoltz SN, 1966). Involvement of the midfoot is most common in the diabetic population and this site tends to be more amenable to conser‐ vative options versus hindfoot or ankle CN. Generally, conservative care for the CN foot and ankle has been recommended for the following scenarios: joints in the acute phase, deformities that are clinically stable and that do not compromise the soft tissue envelope, stable deformities without soft tissue or bone infection, patients who do not have adequate arterial perfusion to support surgical reconstruction, and those patients who are extremely high risk for anesthesia and surgical intervention due to the presence of multiple severe comorbid conditions. In this