From the Guidelines
Treatment of Charcot arthropathy should prioritize offloading the affected joint, immobilization, and preventing further joint destruction, with the primary treatment being non-weight bearing immobilization using a total contact cast or removable walking boot for 3-6 months until the acute inflammatory phase resolves, as recommended by the guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023) 1. The goal of treatment is to reduce inflammation, prevent further joint destruction, and promote healing.
- Key considerations in the treatment of Charcot arthropathy include:
- Offloading the affected joint to reduce mechanical stress and prevent further damage
- Immobilization to prevent further joint destruction and promote healing
- Preventing further joint destruction through the use of assistive devices and custom footwear
- Monitoring for complications such as foot ulcers, skin lesions, and musculoskeletal complaints
- Patient education on the importance of compliance with offloading and regular foot inspections
- The use of a total contact cast or removable walking boot is recommended as the primary treatment for Charcot arthropathy, with the choice of device depending on the individual patient's needs and circumstances 1.
- Treatment with a non-removable knee-high offloading device should be started immediately when active Charcot neuro-osteoarthropathy is suspected, and continued unless an alternative diagnosis is made, in order to prevent the development of deformity 1.
- The use of assistive devices such as crutches or walkers may be necessary to reduce weight-bearing on the affected limb and prevent further joint destruction 1.
- Surgical intervention may be necessary in cases with severe deformity, instability, or ulceration that cannot be managed conservatively, and may include exostectomy, arthrodesis, or reconstruction 1.
From the Research
Charcot Arthropathy Treatment
- Charcot arthropathy, also known as neuropathic osteoarthropathy, is a common complication of diabetes that often is unrecognized and misdiagnosed 2.
- Treatment of Charcot arthropathy typically involves joint immobilization in a total contact cast and then an ankle foot orthosis with custom footwear 2.
- 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 3.
- Two groups of antiresorptive therapies have been evaluated in the treatment of the acute Charcot foot, bisphosphonates (intravenous and oral) and calcitonin, which have clearly shown a reduction of bone turnover, although they have not shown a significant effect on temperature reduction 3.
Immobilization and Weight-Bearing
- Immobilization in a weight-bearing total contact cast appears to be a safe method of treatment of acute Eichenholtz Stage-I Charcot arthropathy of the foot and ankle 4.
- A study found that patients with Charcot arthropathy of the foot and ankle were able to bear weight as tolerated in a total contact cast without any deleterious effect, specifically with regard to skin ulceration or rapid deterioration of the osseous architecture 4.
- Another study supported the use of total contact cast therapy and weightbearing in the treatment of 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 5.
Duration of Treatment
- The median duration of total contact casting for resolution of acute Charcot foot was 4.3 months, with an overall complication rate of 5% per cast 6.
- Osteoarthritis was significantly associated with a longer total contact casting duration, with an odds ratio of 6.00 6.
- A study found that the average time period for treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast was 9.2 weeks 5.