Guidelines Summary

The National Institute for Health and Care Excellence (NICE) of the United Kingdom has published a guideline for the prevention and management of diabetic foot disorders.^[39]Recommendations specifically relevant to Charcot arthropathy in diabetes are as follows.

Investigation

It must be kept in mind that if a person with diabetes fractures a foot or ankle, the fracture may progress to Charcot arthropathy.

Acute Charcot arthropathy should be suspected if redness, warmth, swelling, or deformity (particularly if the skin is intact) is noted, especially in the presence of peripheral neuropathy or renal failure. Acute Charcot arthropathy should be considered even when deformity is not present or pain is not reported.

For confirmation of the diagnosis of acute Charcot arthropathy, the patient should be referred within 1 working day to the multidisciplinary foot care service for triage within 1 further working day. Nonweightbearing (NWB) treatment should be offered until the multidisciplinary foot care service can initiate definitive treatment.

If acute Charcot arthropathy is suspected, a weightbearing radiograph of the affected foot and ankle should be obtained. Magnetic resonance imaging (MRI) may be considered if the radiograph is normal but Charcot arthropathy is still suspected.

Treatment

If the multidisciplinary foot care service suspects acute Charcot arthropathy, treatment with a nonremovable offloading device should be offered. If the use of such a device is inadvisable because of clinical or patient circumstances, treatment with a removable offloading device should be considered.

The use of bisphosphonates to treat acute Charcot arthropathy is not warranted, unless as part of a clinical trial.

Treatment of acute Charcot arthropathy should be monitored via clinical assessment, to include measurement of foot-skin temperature difference and serial radiographs until the acute Charcot arthropathy resolves. Resolution is likely when there is a sustained temperature difference of less than 2º between the two feet and when radiographic changes show no further progression.

People who have a foot deformity that may be the result of a previous Charcot arthropathy are at high risk of ulceration and should be cared for by the foot protection service.

Questions

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Media Gallery

Neuropathic arthropathy (Charcot joint). Neuropathic arthropathy of shoulder in patient with syringomyelia. Note destruction of articular surface, dislocation, and debris, which are pathognomonic for neuropathic joint.
Ankle fracture in 65-year-old diabetic patient.
Ankle fracture fixed by using augmented fixation technique.
Midfoot acute Charcot arthropathy.
Charcot arthropathy. Follow-up at 6 months after internal fixation with "beaming" screws.
Severe fracture dislocation of ankle.
Hindfoot stabilized with hindfoot arthrodesis intramedullary rod.

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Author

Mrugeshkumar Shah, MD, MPH, MS Staff Physician, Physical Medicine and Rehabilitation, Massachusetts General Hospital/Spaulding Rehabilitation Hospital

Mrugeshkumar Shah, MD, MPH, MS 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, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS Professor, Department of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedic Surgery, University of Texas Medical Branch School of Medicine

Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker.

Additional Contributors

James K DeOrio, MD Professor of Orthopedics, Director, Duke Foot and Ankle Fellowship, Duke University Medical Center, Duke University School of Medicine; Associate Professor, Mayo Clinic College of Medicine; Clinical Assistant Professor, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences

James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Association of Graduates, United States Air Force Academy, Doctors Mayo Society, Mayo Clinic Alumni Association, Society of Air Force Clinical Surgeons, Society of Military Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Exactech; Treace Medical; Additive; Mirus; Crossroads Orthopedics<br/>Serve(d) as a speaker or a member of a speakers bureau for: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics<br/>Received income in an amount equal to or greater than $250 from: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics.

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