From the Guidelines
Treatment of Charcot arthropathy should prioritize offloading the affected foot using a non-removable knee-high device to promote remission and prevent deformity, as recommended by the most recent guidelines 1. The primary goal of treatment is to reduce mechanical stress on the affected foot and prevent further joint destruction and deformity.
- The use of a non-removable knee-high device is strongly recommended to immobilize and offload the foot, promoting remission of the disease and preventing progression of deformity in individuals with active Charcot neuro-osteoarthropathy and intact skin 1.
- A total contact cast or a removable walking boot can be considered as alternative options for offloading the foot, but a non-removable knee-high device is the preferred choice 1.
- Assistive devices, such as crutches or walkers, can be used to reduce weight-bearing on the affected limb and promote offloading 1.
- It is essential to avoid using below-the-ankle offloading devices, such as surgical shoes or custom-molded shoes, as they provide inadequate immobilization and offloading capacity 1.
- Treatment with a knee-high offloading device should be initiated as soon as possible after diagnosis, and patients should be closely monitored for signs of inflammation and deformity 1.
- Long-term management of Charcot arthropathy requires vigilant foot care, regular podiatric follow-up, and lifelong use of protective footwear to prevent recurrence and complications 1.
From the Research
Treatment Options for Charcot Arthropathy
- Immobilization of the joint is a crucial step in the treatment of Charcot arthropathy, as it helps to prevent further destruction and promote healing 2, 3, 4, 5, 6.
- Total contact casting (TCC) is a commonly used treatment for Charcot arthropathy, which involves immobilizing the foot and ankle in a cast to prevent trauma and further destruction 3, 4, 5.
- The duration of TCC treatment can vary, but a study found that the median duration was 4.3 months, with an overall complication rate of 5% per cast 5.
- Pharmacologic therapies, such as bisphosphonates and calcitonin, have been evaluated for the treatment of Charcot arthropathy, but the current evidence to support their use is weak 4.
- Patient education and managing expectations are crucial to improve compliance with conservative treatment and avoid long-term sequelae, including severe deformity, ulceration, and amputation 6.
Conservative Management
- Conservative management of Charcot neuroarthropathy involves immobilization, nonweight-bearing, and patient education 6.
- Clinicians should have a high clinical suspicion for Charcot arthropathy in neuropathic patients who present with erythema, edema, and warmth of the foot or ankle 6.
- Immobilization and nonweight-bearing should be immediately initiated when the diagnosis of Charcot has been made, and patients should remain nonweight-bearing until the affected bones/joints have coalesced 6.
Casting Therapy
- Casting therapy has been accepted as the mainstay treatment of the acute Charcot foot, although there are still controversies regarding its duration, the choice of removable and non-removable device, and weight-bearing casts vs. non-weight-bearing casts 4.
- A study found that osteoarthritis was significantly associated with a longer TCC duration, and that the median TCC duration for resolution of acute Charcot foot was 4 months 5.