What is the treatment for Charcot neuroarthropathy (Charcot foot)?

From the Guidelines

The primary treatment for Charcot arthropathy should involve the use of a non-removable knee-high device to immobilize and offload the foot, as recommended by the most recent guidelines 1. This approach is crucial for promoting the remission of the disease, preventing the progression of deformity, and reducing the risk of complications in individuals with active Charcot neuro-osteoarthropathy and intact skin. The following key points are essential in the management of Charcot arthropathy:

• Initial management with a non-removable knee-high device, such as a total contact cast (TCC) or a prefabricated walker made non-removable, is strongly recommended to immobilize and offload the foot 1.
• The use of a removable knee-high device can be considered as a second choice, but it is essential to ensure that the device is worn at all times to maintain offloading and immobilization 1.
• Below-the-ankle offloading devices, such as surgical shoes or custom-molded shoes, are not recommended due to their inadequate immobilization and offloading capacity 1.
• Treatment with a knee-high offloading device should be initiated as soon as possible after the diagnosis of active Charcot neuro-osteoarthropathy is considered, and continued until the disease goes into remission 1.
• Assistive devices, such as crutches or walkers, can be used to reduce weight-bearing on the affected limb and promote healing 1.
• Regular follow-up with a multidisciplinary team, including endocrinology, podiatry, and orthopedics, is crucial for monitoring healing and preventing complications 1. It is also important to note that the treatment of Charcot arthropathy requires a comprehensive approach, including optimization of blood glucose control in diabetic patients, management of pain and inflammation, and prevention of complications such as ulceration and infection 1. By prioritizing the use of non-removable knee-high devices and following these key recommendations, healthcare providers can effectively manage Charcot arthropathy and improve patient outcomes.

From the Research

Treatment Options for Charcot Arthropathy

• Immobilization in a total contact cast is a common treatment approach for Charcot arthropathy, as seen in studies 2, 3, 4, 5.
• The use of weight-bearing total contact casts has been shown to be a safe and effective method for treating acute Charcot arthropathy, with no significant increase in skin ulceration or rapid deterioration of the osseous architecture 4, 5.
• The duration of total contact casting can vary, with a median duration of 4.3 months reported in one study 3.
• Patient education, proper footcare, and footware are essential in preventing further complications, including ulceration and amputation 2.
• There are no established pharmacologic therapies to treat Charcot neuroarthropathy, highlighting the need for novel targeted drug delivery systems to prevent pathologic bone and joint destruction 6.

Treatment Outcomes

• A study found that 48.1% of patients returned to footwear with custom foot orthoses after total contact casting, while 25.9% used a life-long Charcot Restraint Orthotic Walker, and 22.2% had soft tissue or bone reconstructive surgery 3.
• Another study reported that all subjects were able to use commercially available depth-inlay shoes and custom accommodative foot orthoses at an average of 9.2 weeks after treatment with weightbearing total contact cast therapy 5.
• Osteoarthritis was significantly associated with a longer duration of total contact casting, with an odds ratio of 6.00 3.