Abstract
ObjectiveTo develop a new magnetic resonance imaging(MRI) scoring system for evaluation of active Charcot foot and to correlate the score with a duration of off-loading treatment ≥ 90 days.MethodsAn outpatient clinic database was searched retrospectively for MRIs of patients with active Charcot foot who completed off-loading treatment. Images were assessed by two radiologists (readers 1 and 2) and an orthopedic surgeon (reader 3). Sanders/Frykberg regions I–V were evaluated for soft tissue edema, bone marrow edema, erosions, subchondral cysts, joint destruction, fractures, and overall regional manifestation using a score according to degree of severity (0–3 points). Intraclass correlations (ICC) for interreader agreement and receiver operating characteristic analysis between MR findings and duration of off-loading-treatment were calculated.ResultsSixty-five feet in 56 patients (34 men) with a mean age of 62.4 years (range: 44.5–85.5) were included. Region III (reader 1/reader 2: 93.6/90.8%) and region II (92.3/90.8%) were most affected. The most common findings in all regions were soft tissue edema and bone marrow edema. Mean time between MRI and cessation of off-loading-treatment was 150 days (range: 21–405). The Balgrist Score was defined in regions II and III using soft tissue edema, bone marrow edema, joint destruction, and fracture. Interreader agreement for Balgrist Score was excellent: readers 1/2: ICC 0.968 (95% CI: 0.948, 0.980); readers 1/2/3: ICC 0.856 (0.742, 0.917). A cutoff of ≥ 9.0 points in Balgrist Score (specificity 72%, sensitivity 66%) indicated a duration of off-loading treatment ≥ 90 days.ConclusionThe Balgrist Score is a new MR scoring system for assessment of active Charcot foot with excellent interreader agreement. The Balgrist Score can help to identify patients with off-loading treatment ≥ 90 days.
Highlights
The Charcot foot is a potentially devastating complication of patients with peripheral polyneuropathy leading to considerable bone destruction, foot deformity, and risk of pedal ulcer formation [1,2,3,4]
The typical end shape of a Charcot foot is the so-called rockerbottom deformity [8]. Patients often perceive their quality of life as poor, since a foot with rockerbottom deformity cannot be equipped with commercial footwear, making ulcer formations and infections very likely
Patients are frequently treated with a custom-made, removable, total contact cast until the signs of active Charcot foot are substantially reduced or absent [4]
Summary
The Charcot foot is a potentially devastating complication of patients with peripheral polyneuropathy leading to considerable bone destruction, foot deformity, and risk of pedal ulcer formation [1,2,3,4]. In the early disease stage, an acute (i.e., active) Charcot foot shows major signs of inflammation, including redness, edema, and hyperthermia— overlapped by subsequent stages of bone fragmentation and joint destruction. Anatomical and imaging-based systems are available for Charcot foot classification, the most common ones being the Brodsky classification [10] (modified by Trepman et al [11]), the Sanders/Frykberg classification [12], and the Eichenholtz classification [13] (modified by Shibata et al [14]). These classifications rely on conventional radiographs for disease evaluation. No imaging parameter is currently available to predict the approximate duration of off-loading therapy, especially in order to help prepare patients for a treatment longer than 3 months (90 days)
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