Charcot Arthropathy Guidelines

Updated: Jun 21, 2018
  • Author: Mrugeshkumar Shah, MD, MPH, MS; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Guidelines

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. [26] 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.