Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker

作者：Christensen Tomas M^*; Gade Rasmussen Birthe; Pedersen Lis W; Hommel Eva; Holstein Per E; Svendsen Ole L

来源：Journal of Diabetes and Its Complications, 2012, 26(5): 430-434.

DOI：10.1016/j.jdiacomp.2012.05.006

• Charcot foot
• Diabetes
• Charcot osteoarthropathy
• Diabetic neuropathi
• Off-loading

Objective: Recent literature on acute diabetic Charcot osteoarthropathy (CA) reports unusually long periods of off-loading. Data suggest that this might increase the re-currence rate. Subsequently we evaluated the influence of duration of off-loading on the risk of required re-casting.
Research Design and Methods: In this retrospective consecutive series from 2000 to 2005, 56 people with diabetes and an acute Charcot foot were included. The inclusion criteria were an initial persistent temperature difference more than 2 degrees C between the two feet, oedema, and typical hot spots on a bone scintigram, radiology, and a typical clinical course. Treatment was off-loading in a removable cast and 2 crutches. In-door walking was allowed. Gradually augmented weight bearing was prescribed when the skin temperature difference had decreased to a level less than 2 degrees C and edema had subsided. Re-casting was required for immediate exacerbation during re-load as well as for recurrence - defined as new swelling and skin temperature difference of more than 2 degrees C in the same foot occurring after a stable interval of at least one month after full weight bearing.
Results: The duration of off-loading for all patients was 141 +/- 21 days (mean +/- SD). Three patients (5%) were re-casted immediately for exacerbation after re-load and 7 patients (12 %) after recurrence of the CA. Duration of re-casting was 79 +/- 44 days. The primary period of off-loading was not statistically significantly different for those not requiring versus those requiring re-casting: 142 +/- 24 days compared to 134 +/- 41 days. Neither were the differences in demographic data, metabolic regulation, BMI or localization of CA.
Conclusions: Patients with risk of exacerbation or recurrence of CA could not be identified in the present study and there was no relation to the duration of off-loading. Nevertheless off-loading periods with immobilisation should be kept as short as possible, due to other side effects. This can be obtained by early gradual augmented re-loading.

• 出版日期2012-10