eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Charcot Arthropathy: Follow-up

Author: Mrugeshkumar Shah, MD, MPH, Staff Physician, Physical Medicine and Rehabilitation, Massachusetts General Hospital/Spaulding Rehabilitation Hospital
Coauthor(s): Walter Panis, MD, Clinical Instructor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School
Contributor Information and Disclosures

Updated: Aug 29, 2007

Outcome and Prognosis

Outcomes for Charcot arthropathy are based on immediate diagnosis and treatment. A more favorable outcome is elicited when joints are treated within 2 weeks of injury and when there is strict adherence to weight-bearing precautions.

Location of the disease also affects outcome. Forefoot arthropathies heal in less time than midfoot, hindfoot, or ankle arthropathies. Average healing times are as follows:

  • Ankle - Mean time, 83 days, +/- 22 days
  • Hindfoot - Mean time, 97 days, +/- 16 days
  • Midfoot - Mean time, 96 days, +/- 11 days
  • Forefoot - Mean time, 55 days, +/- 17 days)

Surgical treatment prolongs healing time. The extent of the injury also affects healing time. The more severe the injury, the longer it takes to heal and the greater the likelihood of permanent deformity. It generally takes 1-2 years to completely heal a Charcot joint, from the active phase to quiescence.

Future and Controversies

The current mainstay of therapy for patients with Charcot arthropathy is immobilization and NWB on the affected extremity. However, other treatment options are currently being tested. One option is the use of bisphosphonates, which are potent inhibitors of bone resorption that have minimal effect on bone formation.5,6 This action stops the osteoclastic activity of bone breakdown, promotes healing, and decreases local inflammation. However, only a few case reports have examined this treatment as an alternative.

Another therapy that is currently being researched is low-intensity ultrasound.7 Pulsed low-intensity ultrasound has been shown to transmit micromechanical force and strains to the fracture site and to promote bone formation. Studies have demonstrated an acceleration in healing and an increase in strength at the callus site.

Finally, the use of electrical stimulation and of magnetic field therapy to stimulate bone formation has been discussed in a few case reports. These therapies have shown some benefit in accelerating healing times. However, no prospective studies indicate a positive effect.

 


More on Charcot Arthropathy

Overview: Charcot Arthropathy
Workup: Charcot Arthropathy
Treatment: Charcot Arthropathy
Follow-up: Charcot Arthropathy
References
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References

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Further Reading

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Keywords

Charcot joint, neuropathic osteoarthropathy, diabetic osteoarthropathy, diabetic neuroarthropathy, Charcot foot, Charcot neuroarthropathy, neuropathic arthropathy, neuropathic joint, Schon classification, Brodsky and Rouse system, Saunders and Mrdjencovich system

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Contributor Information and Disclosures

Author

Mrugeshkumar Shah, MD, MPH, Staff Physician, Physical Medicine and Rehabilitation, Massachusetts General Hospital/Spaulding Rehabilitation Hospital
Mrugeshkumar Shah, MD, MPH is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Walter Panis, MD, Clinical Instructor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School
Walter Panis, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neurorehabilitation, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St. Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Shepard R Hurwitz, MD, Director of Clinical Services, Department of Orthopedic Surgery, University of Virginia School of Medicine; Director, Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, University of Virginia Health System
Shepard R Hurwitz, MD is a member of the following medical societies: American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, and Orthopaedic Trauma Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FAAOS, Chairman, J Vernon Luck Distinguished Professor, Department of Orthopedic Surgery, University of Missouri
Jason H Calhoun, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and American Orthopaedic Foot and Ankle Society
Disclosure: Nothing to disclose.

 
 
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