Recognition and management of acute neuropathic (Charcot) arthropathies of the foot and ankle.

STUDY DESIGN: Review of selected literature describing the outcomes related to the management of acute Charcot foot arthropathies in patients with diabetes mellitus.

OBJECTIVE: To familiarize the rehabilitation specialist with the general principles of nonsurgical management for patients with acute neuropathic arthropathies of the foot and ankle.

BACKGROUND: Neuropathic (Charcot) arthropathy of the foot or ankle is the most destructive and disabling chronic complication of all diabetic foot disease.

METHODS AND MEASURES: We discuss the clinical presentation and the role that orthopaedic and sports physical therapists may have in identifying and preventing complications and the long-term disability associated with these arthropathies. We summarize the outcomes of 15 published reports from 1985-1999 located using the MEDLINE database from 1966-present. Studies were selected and included if the authors reported on (1) 2 or more patients with diabetes mellitus and acute Charcot arthropathies; (2) the short-term or long-term outcomes, including the length of follow-up; and (3) the pattern or location of the arthropathy. The short-term outcomes (percentage of patients healed, average time to healing) and long-term outcomes (percentage in whom treatment failed, amputation, disability) after treatment by immobilization alone or immobilization after surgery were reviewed and summarized.

RESULTS: The prognosis for an individual with severe neuropathic skeletal foot deformities is poor. Eleven deaths (3.65%) in 301 patients were reported within the average follow-up period of 2.5 years after treatment for Charcot arthropathy. Partial or complete foot amputation occurred in 20 (6.6%) of 301, whereas 83 (28%) of 301 patients reviewed had mobility limitations or required ankle-foot orthoses or permanent bracing or assistive devices for ambulation at the time of follow-up.

CONCLUSION: Rehabilitation specialists can improve the short-term outcomes and limit the long-term disabilities in patients with diabetes mellitus and peripheral neuropathy. Early recognition and prompt immobilization are the basic principles of nonsurgical management that influence therapeutic outcome.