Acute Charcot Foot Research Articles

170-OR: Case-Control Study on Whole-Methylome Analysis of Monocytes in Acute Diabetic Charcot Foot—Identifying Differentially Methylated Genes

170-OR: Case-Control Study on Whole-Methylome Analysis of Monocytes in Acute Diabetic Charcot Foot—Identifying Differentially Methylated Genes

Evaluation of acute Charcot foot with radiographs or MRI scans?

Evaluation of acute Charcot foot with radiographs or MRI scans?

Diagnosis and management of acute Charcot foot

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

THE MANAGEMENT OF DIABETIC FOOT IN THE EMERGENCY

Background:Diabetic foot ulcers infected mainly increase the risk of amputation. The aim of our study was to define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency Aims: To define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency Patients/methods: This is a prospective observational study spread over twelve months in the medical and surgical emergencies including 108 patients. We investigated socio-demographic, clinical data and treatment of patients hospitalized for diabetic foot. Results: The mean age of patients was 63.7ans, 92.6% were diabetic type2. 57.4% of lesions were acute (ulcers (37%), wet gangrene (33.3%), dry gangrene (13%),cellulitis (24.1%) and acute Charcot foot (9.3%)), 63% following a trauma and 33.2% due to unsuitable footwear. 81.5% had clinical signs of angiopathy and 64.5% of neuropathy. The lesions were classified: uninfected (9.3%), low (9.3%), moderate (38.8%) and severe (42.6%) according to the IDSA / IWGDF and 0D (46.3%) 3D (18.5%) 3B (7.4%) according to the University of Texas. Staphylococcus aureus was the most germ solved. Antibiotics administered if osteitis was Amoxicillin-clavulanate (57.5%) and Ertapenem (31.5%) in his absence. 14.8% received debridement, 1.9% for revascularization and 83.3% for amputation. In our study, the risk of amputation increases with the average socioeconomic level, severity of the infection and the presence of osteitis /osteomyelitis while drying feet after ablution was a protective factor. 9.3% of recurrence and 5.6% of deaths were recorded. Conclusions: The multidisciplinary management of diabetic foot is paramount. The surgery is common immediately but rarely necessary, medical treatment is the first-line therapy avoiding abusive amputations. Prevention requires the establishment of specialized units. Summary:Diabetic foot ulcers infected mainly increase the risk of amputation. The aim of our study was to define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency. This is a prospective observational study spread over twelve months in the medical and surgical emergencies including 108 patients. In our study, the risk of amputation increases with the average socioeconomic level, severity of the infection and the presence of osteitis /osteomyelitis while drying feet after ablution was a protective factor. 9.3% of recurrence and 5.6% of deaths were recorded.

Mini-Invasive Approach and Minor Amputation in the Management of Diabetic Foot Ulcer: A Retrospective Study of 110 Cases

Category:Diabetes; OtherIntroduction/Purpose:The diabetic foot is an increasing issue over the last years. The 25% of diabetic patients have a risk to develop a diabetic foot ulcer (DFU) in their lifetime, among these, the 28% of patients will result in an amputation. The amputation is associated with a high rate of complications. Therefore, percutaneous mini-invasive (PMI) approaches and minor amputations (MA) have a widespread use in the last years. The aim of our work is to evaluate the clinical and functional outcomes of PMI and MA in the treatment of recurrences and unhealed DFU after conservative treatment.Methods:We retrospectively enrolled 110 patients treated in our orthopedic department in Perugia between January 2012 and October 2019. Included were the patients underwent to a PMI or MA treatment after failed conservative treatment for 12 weeks. The PMI technique consist of flexor tenotomy, metatarsal osteotomy and resection arthroplasty sec. Kessler. DFU were classified according to the Texas Foot Ulcer Classification. Exclusion criteria were: patient affected by peripheral vasculopathy disease, previous major amputation, psychiatric disease. The patients were divided in 2 groups. The group A included 57 patients treated with PMI, mean age 62.8 y.o. (range 50-80). The group B included 53 patients treated with MI, mean age 66.2 y.o. (range 53-85). The mean follow up was 18 months (range 4-40 months). Clinical outcomes, complication's rate, functional scores (FFI and VAS- FA) were assessed. The statistical analysis was performed with the t-student test, the significativity value was set p<0.05.Results:In the group A, the patients had a healing's rate in 90,7 % of cases, the ulcer was healed in average in 5.77 weeks ( range 4-8.1). The postoperative complications accounts 35% of cases, including 2 cases of osteomyelitis, 1 acute Charcot foot, 1 case of acute renal insufficiency and pneumonia. Transfer ulcer occurred in 12.96%. Overall a reintervention with a mini-invasive approach was performed in 2 cases. Group B healed in 77% of cases, in a mean time of 9.11 weeks (range 8-13.3), no postoperative complication occurred. In 23% of patients occurred a transfer ulcer after an average time of 30 months, in 1 case a major amputation was mandatory. The mean value at postoperative follow-up was 78 for VAS-FA for group A and 72.2 for group B, the FFIindex was 70% for group A and 68% for group B.Conclusion:The PMI and AM are effective procedures for the treatment of DFU, associated with low complications rate, fast recovery and ulcer's healing process, low rate of recurrences and ulcer transfer. Overall the percutaneous technique show encouraging results, however, these procedures must be addressed to the patient's feature. As prospective, in the future percutaneous treatments might play a role in prevention's strategy.

Mortality in Patients after Diabetic Charcot Foot-Related Procedures

Category:Diabetes; Hindfoot; Midfoot/ForefootIntroduction/Purpose:Diabetic Charcot foot is a chronic and progressive disease, following neuropathic loss of protective sensation and causing destruction of the joints. It is classically identified through a rocker-bottom deformity and may also present with a collapse of the medial arch, bony prominences, and ligamentous instability. Charcot leads to further morbidities, and patients may require surgeries including below the knee amputations or limb salvage reconstruction to treat the disease if conservative treatments fail. Previous literature demonstrated that foot ulceration is associated with mortality in diabetic patients, but no clear association between Charcot diagnosis and mortality has been identified. The purpose of this study was to investigate the mortality in patients diagnosed with acute diabetic Charcot foot.Methods:After institutional review board approval, all patients at a single institution that underwent an orthopaedic surgery for the treatment of Charcot during 2015-2020 were queried using hospital and public records. Demographic data, as well as the 30- day, 90-day, 1-year, and 5-year mortality were recorded.Results:79 patients were identified, with 57 (72%) males and 22 (28%) females with Charcot-related surgeries between 2015 and 2020. At the time of surgery, the average age was 58.2 (28-83) years. At the time of analysis, 61 (77%) patients were still living, but 18 (23%) patients were deceased with mortality within 30 days (1), 90 days (5), 1 year (9), and 5 years (18) of the Charcot-related procedure. For deceased patients, the average age of death was 59.6 years (30-83 years). The average number of days post- operation until death was 460 days (23-1613 days).Conclusion:Diabetic Charcot foot is a serious and debilitating complication of diabetic neuropathy. This data demonstrates that 23% of patients analyzed expired an average of 1.26 years after Charcot-related surgery. In addition, patients that were deceased were an average of 59.6 years of age, suggesting that Charcot may be associated with early mortality. Future studies will include an analysis of possible predictors of mortality for patients diagnosed with Charcot foot to evolve clinical and surgical management of patients.

Effect of Recombinant Human Parathyroid Hormone (1-84) on Resolution of Active Charcot Neuro-osteoarthropathy in Diabetes: A Randomized, Double-Blind, Placebo-Controlled Study

OBJECTIVEFractures in Charcot neuro-osteoarthropathy (CN) often fail to heal despite prolonged immobilization with below-knee casting. The aim of the study was to assess the efficacy of recombinant human parathyroid hormone (PTH) in reducing time to resolution of CN and healing of fractures.RESEARCH DESIGN AND METHODSPeople with diabetes and acute (active) Charcot foot were randomized (double-blind) to either full-length PTH (1-84) or placebo therapy, both in addition to below-knee casting and calcium and vitamin D3 supplementation. The primary outcome was resolution of CN, defined as a skin foot temperature difference >2°C at two consecutive monthly visits.RESULTSMedian time to resolution was 5 months (95% CI 4, 12) in intervention and 6 months (95% CI 2, 9) in control. There was no significant difference in time to resolution between the groups (mixed-effects logistic regression; P = 0.64). The hazard ratio of resolution was 0.84 (95% CI 0.41, 1.74; P = 0.64), and the odds ratio of resolution by 12 months was 1.22 (0.90, 1.67; P = 0.20) (intervention vs. control). On linear regression analysis, there were no significant differences in the effect of treatment on fracture scores quantitated on MRI scans (coefficient 0.13 [95% CI −0.62, 0.88]; P = 0.73) and on foot and ankle X-rays (coefficient 0.30 [95% CI −0.03, 0.63]; P = 0.07).CONCLUSIONSThis double-blind placebo-controlled trial did not reduce time to resolution or enhance fracture healing of CN. There was no added benefit of daily intervention with PTH (1-84) to below-knee casting in achieving earlier resolution of CN.

Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study

BackgroundCharcot neuroarthropathy (Charcot foot) is a highly destructive joint disease of the foot and ankle. If there is delayed diagnosis and treatment, it can lead to gross deformity, instability, recurrent ulceration and/or amputation. Total contact casting (TCC) is a treatment commonly used to immobilise the foot and ankle to prevent trauma, further destruction and preserve the foot structure during the inflammatory phase. At present, there is limited Australian data regarding the duration of TCC treatment for resolution of acute Charcot foot, and whether there are any patient and clinical factors affecting its duration. Therefore, this study aimed to address these deficiencies.MethodsThis study presents a retrospective analysis of 27 patients with acute Charcot foot attending for TCC treatment at a high-risk foot service (HRFS) in a large metropolitan health network in Melbourne, Australia. Over a three-year period, data were retrospectively collected by reviewing hospital medical records for clinical, demographic, medical imaging and foot examination information. To explore between-group differences, independent samples t-tests, Mann-Whitney U tests, Chi-square tests, and/or Fisher’s exact tests were calculated depending on data type. To evaluate associations between recorded variables and duration of TCC treatment, mean differences, odds ratios (OR) and 95% confidence intervals were calculated.ResultsMean age was 57.9 (SD, 12.6) years, 66.7% were male, 88.9% had diabetes, 96.3% had peripheral neuropathy, and 33.3% had peripheral arterial disease. Charcot misdiagnosis occurred in 63.0% of participants, and signs and symptoms consistent with acute Charcot foot were present for a median of 2.0 (IQR, 1.0 to 6.0) months prior to presenting or being referred to the HRFS. All participants had stage 1 Charcot foot. Of these, the majority were located in the tarsometatarsal joints (44.4%) or midfoot (40.7%) and were triggered by an ulcer or traumatic injury (85.2%). The median TCC duration for resolution of acute Charcot foot was 4.3 (IQR, 2.7 to 7.8) months, with an overall complication rate of 5% per cast. Skin rubbing/irritation (40.7%) and asymmetry pain (22.2%) were the most common TCC complications. Osteoarthritis was significantly associated with a TCC duration of more than 4 months (OR, 6.00). Post TCC treatment, 48.1% returned to footwear with custom foot orthoses, 25.9% used a life-long Charcot Restraint Orthotic Walker, and 22.2% had soft tissue or bone reconstructive surgery. There were no Charcot recurrences, however, contralateral Charcot occurred in 3 (11.1%) participants.ConclusionsThe median TCC duration for resolution of acute Charcot foot was 4 months, which is shorter or comparable to data reported in the United Kingdom, United States, Europe, and other Asia Pacific countries. Osteoarthritis was significantly associated with a longer TCC duration. The findings from this study may assist clinicians in providing patient education, managing expectations and improving adherence to TCC treatment for acute Charcot neuroarthropathy cases in Australia.

Short-term outcomes of treatment of active stage of Charcot foot in outpatient setting

Background: Treatment options in patients with an acute Charcot foot is not well standardized and still challenging.Aims: To evaluate the results of the non-operative treatment of patients with active stage of diabetic charcot arthropathy in outpatient foot clinic and to identify factors influenced on treatment results.Materials and methods: Medical files of 141 patients with unilateral ulcer-free active charcot arthropathy were reviewed. 78 patients agreed for treatment (total contact cast or walker), 63 patients refused of treatment (follow-up only). The time of resolution of the acute stage, severity of final deformities and foot-related complications were evaluated. Refusers were asked about the cause of their decision.Results: Mean delay of the diagnosis was 3,2±2,8 months. Main causes of the refuse were: mistrust to doctor - 38%, problems with employment - 33%, home/family problems - 18%, medical reasons - 11%. Median healing times (months) in the treatment group vs controls: 9 (6 - 19) 15 (13 - 25) (p=0,001) and progression of the initial deformity: 14% and 35%, respectively (p=0,01). Foot-related complications: 17,5% in the treatment group and in 55,6% of controls (including 6 amputations) (p=0,001). Frequency of breaking the cast/walker - 32%/16,6%. Foot lesions due to cast/walker: 13,6%/41,7% (p&lt;0,01). Median healing times (months) with walkers - 13 (11 - 19), with casts - 9 (6 - 15) months (р=0,02). The use of crutches shortened healing time.Conclusions: The significant delay of diagnosis was revealed. The refuse rate in our cohort was high and main causes of the refuse were social and psychological. Neglect of treatment leads to high frequency and severity of foot-related complications. We noticed high rate of breaking of walkers and casts and device-related foot lesions. Total contact casts were more effective and safe compared with walkers.

Combination of active stage of diabetic Charcot neuroosteoarthropathy and diabetic lower limb macroangiopathy

Combination of active stage of diabetic Charcot neuroosteoarthropathy and diabetic lower limb macroangiopathy is the rare condition. In the present paper we describe two cases of development of acute Charcot foot in the non-critically ischemic foot. The first case is the patient with previously diagnosed intermitted claudication and the second case is patient who developed the Charcot foot 5 months later after successful endovascular treatment of arterial occlusions of his left lower limb. In both cases the absence of redness in the early stage, the mild-to-moderate pain and mild temperature gradient between affected and non-affected feet were noticed. The clinical course of the Charcot disease in the first patient was favourable. He used walker for 9 months and his foot shape was preserved and deformity was considered as mild. The second patient had more active and profound destructions due to delay of the treatment. He was casted, however his deformity progressed and the treatment continues up to date. In both patients the MRI revealed more affected bones compared with X-ray. These cases emphasize the importance of keeping in mind the Charcot disease even in patients with diabetic peripheral vascular disease.

Distribution and analysis of Charcot foot in diabetes through Amit Jain’s extended “SCC” classification

Objective: To analyze and distribute the Charcot foot in diabetes through the new Amit Jain’s classification for Charcot foot (E “SCC”) and to predict outcomes associated with this new classification.Materials and Methods: A descriptive retrospective analysis was conducted at 2 different centers in Bengaluru city, India. The study period was for 2 years. An IEC clearance was obtained prior to the study. Statistical analysis was done using SPSS 22 and R environment Ver.3.2.2.Results: A total of 16 patients were studied who fulfilled inclusion criteria. Majority were males accounting for 68.85% of the cases. 31.3% had acute Charcot foot. Majority of the patients were in type 1 Charcot foot. Midfoot was most commonly involved with pattern III being most common affecting 75% of the patients. Major amputation occurred in 12.5% of the cases and osteomyelitis was significantly associated with major amputation (P-0.008). TCC and Removable cast walker were significantly used in acute Charcot foot.Conclusion: In this validation study, it is seen that majority of the Charcot foot in clinical practice were of simple type and surgeries were done in type 3 Charcot foot. All the major amputation occurred in type 3 Charcot foot and osteomyelitis had significant association with amputation. There was no mortality in this study. Amit Jain’s classification for Charcot foot is a simple, practical, easy to remember focal classification that guides therapy, serves a good teaching and communicative tool.

RANKL Gene Polymorphism as a Potential Biomarker to Identify Acute Charcot Foot Among Indian Population With Type 2 Diabetes: A Preliminary Report.

Studies addressing the link between gene polymorphism and Charcot neuropathic osteoarthopathy (CN) have been limited to analyse osteoprotegerin gene. Aim is to understand the association of RANKL gene variants on the susceptibility of diabetic neuropathy and CN and to measure the serum levels of sRANKL among Indian population with type 2 diabetes. 77 subjects (48 males: 29 females) were recruited and divided into 3 groups. Group 1 Control: normal glucose tolerance (NGT). Group 2: Type 2 diabetes mellitus and neuropathy (DPN). Group 3: Established type 2 diabetes mellitus, DPN, and CN. Subjects were genotyped for RANKL SNP 693 C/G and 643 C/T using polymerase chain reaction-restriction fragment length polymorphism. sRANKL levels were measured using ELISA (enzyme-linked immunosorbent assay). The serum levels of sRANKL were significantly different between the 3 groups. In RANKL -643 C/T the frequency of "CT" genotype and the minor allele "T" was greater among the DPN and CN group compared with the NGT. Further statistical analysis found a significant difference in genotypic frequencies between DPN and NGT subjects with CT genotype. In RANK L -693 C/G the frequency of homozygote mutant "GG" and the minor allele "G" was greater among the DPN and CN group compared with the NGT. Significant differences in genomic frequencies were observed among "GG" genotype. RANKL -643 C/T was significantly associated with DPN alone while -693 C/G was significantly associated with both DPN and CN. Thus, the study suggests RANKL polymorphism might be considered as an independent risk factor for the development of CN.

What Is the Best Method to Differentiate Acute Charcot Foot From Acute Infection?

Differentiation between acute Charcot neuroarthropathy (CN) and acute infection/osteomyelitis is complex and requires multiple (>1) diagnostic criteria. These criteria include an emphasis on the presence of neuropathy, history, and physical examination. The absence of skin wounds and resolution of swelling/erythema with elevation makes the likelihood of infection very low. In unclear cases, laboratory testing, histologic examination and culturing of bone specimens, scintigraphy, and imaging, especially magnetic resonance imaging (MRI), may be of benefit. Moderate. Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

Whole-methylome analysis of circulating monocytes in acute diabetic Charcot foot reveals differentially methylated genes involved in the formation of osteoclasts.

To assess whether DNA methylation of monocytes play a role in the development of acute diabetic Charcot foot (CF). We studied the whole methylome (WM)of circulating monocytes in 18 patients with Type 2 diabetes (T2D) and acute CF, 18 T2D patients with equivalent neuropathy and 18 T2D patients without neuropathy, using the enhanced reduced representation bisulfite sequencing technique. WM analysis demonstrated that CF monocytes are differentially methylated compared with non-CF monocytes, in both CpG-site and gene-mapped analysis approaches. Among the methylated genes, several are involved in the migration process during monocyte differentiation into osteoclasts or are indirectly involved through the regulation of inflammatory pathways. Finally, we demonstrated an association between methylation and gene expression in cis- and trans-association.

The acute Charcot foot in diabetics: Diagnosis and management.

Acute Charcot foot is a diagnostic challenge.The exact pathophysiology is not fully understood.Acute Charcot foot is often present with a history of trauma or cellulitis which does not respond to antibiotics.The condition is best managed within a multidisciplinary team.The mainstay of the treatment is mechanical off-loading and total contact casting.Surgery is reserved for select cases.Cite this article: EFORT Open Rev 2018;3:568-573. DOI: 10.1302/2058-5241.3.180003

Mortality and complications after treatment of acute diabetic Charcot foot

AimsCharcot foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot foot on a case-by-case basis, in order to assess the consequences of an acute Charcot foot and its complications. MethodsThe study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry. ResultsIn total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7 ± 21.4 mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5 ± 20.3 mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3 months). The 5-year mortality was 14% with a mean survival time of 12.7 years. There was an association between lack of compliance and occurrence of foot complications, as well as between having a Charcot foot and leaving the workforce. ConclusionMore patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot foot.

Markers of Local Inflammation and Bone Resorption in the Acute Diabetic Charcot Foot.

Objective Due to the localized nature of Charcot foot, systemically altered levels of inflammation markers can be difficult to measure. The aim of this study was to investigate whether it is possible to detect an arteriovenous (A-V) flux in any locally produced inflammatory biomarkers from an acute Charcot foot by comparing local and systemic measurements. Methods We included patients with acute diabetic Charcot foot. Blood was sampled from the vena saphena magna on the distal part of the crus bilaterally as well as from the arteria radialis. To minimize the A-V shunting effect, the feet were externally cooled with ice water prior to resampling. Results Both before and after cooling, the A-V flux of interleukin-6 (IL-6) between the Charcot feet and the arterial level was significantly higher than the flux between the healthy feet and the arterial level (Δvaluebefore: 7.25 versus 0.41 pg/mL, resp., p = 0.008; Δvalueafter: 10.04 versus 1.68 pg/mL, resp., p = 0.032). There were no differences in the fluxes for other markers of inflammation. Conclusion We have found an increased A-V flux of IL-6 in the acute diabetic Charcot foot compared to the healthy foot in the same patients.

Role of bisphosphonates in the management of acute Charcot foot.

Diabetes mellitus is the most common cause of Charcot neuropathy affecting foot and ankle. Acute Charcot foot (CF) presents with a red and swollen foot in contrast to the painless deformed one of chronic CF. Enhanced osteoclastogenesis plays a central role in the pathogenesis of acute CF. Many studies have shown elevated levels of bone turnover markers in patients with acute CF confirming it. These findings have led clinicians to use anti-resorptive agents [bisphosphonates (BP), calcitonin, and denosumab] along with immobilization and offloading in acute CF patients. The maximum evidence among all anti-resorptive agents is available for BPs, although its quality is low. Pamidronate has been shown to reduce the markers of activity of CF like raised skin temperature, pain, edema, and bone turnover markers in the majority of studies. Intravenous BPs are known to cause acute phase reactions leading to flu-like illness following their first infusion, which can be ameliorated by oral acetaminophen. Alendronate is the only oral BP used in these patients. It needs to be taken on an empty stomach with a full glass of water to avoid esophagitis. The side-effects and contraindications to BPs should be kept in mind while treating acute CF patients with them.

Differentially expressed circulating microRNAs in the development of acute diabetic Charcot foot.

Aim:Charcot foot (CF) is a rare complication of Type 2 diabetes (T2D).Materials & methods:We assessed circulating miRNAs in 17 patients with T2D and acute CF (G1), 17 patients with T2D (G2) and equivalent neuropathy and 17 patients with T2D without neuropathy (G3) using the high-throughput miRNA expression profiling.Results:51 significantly deregulated miRNAs were identified in G1 versus G2, 37 in G1 versus G3 and 64 in G2 versus G3. Furthermore, we demonstrated that 16 miRNAs differentially expressed between G1 versus G2 could be involved in osteoclastic differentiation. Among them, eight are key factors involved in CF pathophysiology.Conclusion:Our data reveal that CF patients exhibit an altered expression profile of circulating miRNAs.

Salient features and outcomes of Charcot foot – An often-overlooked diabetic complication: A 17-year-experience at a diabetic center in Bangkok

BackgroundCharcot foot is a rare but a serious diabetic condition. Recognition of this often overlooked condition to provide timely and proper management is important for a better prognosis. Limited data on Charcot foot was available in Asians. AimsThe aim of this study is to describe salient features and outcomes of Charcot foot in Thai patients. MethodWe presented our experience of 40 cases of Charcot foot patients who were treated from 2000 to 2016 at Theptarin Hospital, Bangkok, Thailand. ResultsA total of 40 Charcot foot patients were identified (13 acute, 27 chronic; mean age 58.7 ± 10.2 years; duration of diabetes 18.0 ± 8.8 years; T2DM 95%). The average serum HbA1c level was 9.2 ± 1.9%. While acute Charcot foot was frequently misdiagnosed as cellulitis in almost one-third of patients, osteomyelitis was a leading cause of misdiagnosis in 15% of chronic Charcot foot patients. Ulcer-free rate at 6 and 12 months were observed in 60% and 58% of patients, respectively. The mortality rate was 13% during a median follow-up period of 57 months. Only 61% of the patients resumed walking normally while almost one-fourth of them were wheelchair-bound. ConclusionsCharcot foot in Thai patients mainly developed in long-standing poorly controlled type 2 diabetes with neuropathy, and presented late in the course of the disease. It was often misdiagnosed resulting in improper management and poor outcome which included amputation.