What is the treatment for acute Charcot (Charcot-Marie-Tooth disease) foot?

From the Guidelines

The treatment of acute Charcot foot requires immediate non-weight bearing immobilization using a non-removable knee-high device, such as a total contact cast, to promote remission and prevent deformity, as recommended by the International Working Group on the Diabetic Foot (IWGDF) guidelines 1. The primary goal of treatment is to prevent further bone destruction and deformity, which can lead to significant disability if not properly managed in its acute phase. Key aspects of treatment include:

• Immobilization and offloading of the affected foot using a non-removable knee-high device, with a total contact cast being the preferred method due to its ability to better immobilize the ankle and accommodate deformity or significant edema 1.
• The use of assistive devices, such as crutches or a wheelchair, to reduce weight-bearing on the affected limb and prevent musculoskeletal complications and pain in the contralateral extremity 1.
• Regular monitoring with serial X-rays every 2-4 weeks to assess bone position and healing, and to adjust the treatment plan as necessary 1.
• Tight glycemic control for diabetic patients to promote healing, as hyperglycemia can impede the healing process and worsen outcomes 1.
• Consideration of surgical intervention for cases with severe deformity, instability, or ulceration that cannot be managed conservatively, although this is generally reserved for complex cases 1. It is essential to note that the treatment of acute Charcot foot should be individualized, taking into account the patient's specific needs, preferences, and circumstances, and that a multidisciplinary approach, including input from healthcare professionals with expertise in diabetes, orthopedics, and podiatry, is often necessary to achieve optimal outcomes 1.

From the Research

Treatment Options for Acute Charcot Foot

• Total contact casting (TCC) is a commonly used treatment to immobilize the foot and ankle, preventing further destruction and preserving foot structure during the inflammatory phase 2, 3, 4.
• The median TCC duration for resolution of acute Charcot foot was 4.3 months, with an overall complication rate of 5% per cast 2.
• Osteoarthritis was significantly associated with a longer TCC duration 2.
• Weightbearing total contact cast therapy can be an effective treatment option for acute Charcot foot arthropathy, with all subjects able to use commercially available depth-inlay shoes and custom orthoses at an average of 9.2 weeks 4.
• Orthotic management, including the use of a Charcot restraint orthotic walker (CROW) or prefabricated diabetic walker (DW), can be used for the treatment of Charcot feet after external fixation surgery 5.

Considerations for Treatment

• Charcot misdiagnosis can occur in a significant proportion of patients, highlighting the importance of accurate diagnosis and timely treatment 2.
• Skin rubbing/irritation and asymmetry pain are common complications of TCC treatment 2.
• Patient education and managing expectations are crucial for improving adherence to TCC treatment 2.
• The choice of orthotic management depends on medical, social, and economic circumstances, and there is no single orthosis suitable for all patients with Charcot feet 5.