Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Nov 16;18(1):460.
doi: 10.1186/s12891-017-1818-4.

Treatment of Charcot Neuroarthropathy and osteomyelitis of the same foot: a retrospective cohort study

Martin Berli  1 , Lazaros Vlachopoulos  2 , Sabra Leupi  2 , Thomas Böni  2 , Charlotte Baltin  2
Affiliations

Treatment of Charcot Neuroarthropathy and osteomyelitis of the same foot: a retrospective cohort study

Martin Berli et al. BMC Musculoskelet Disord. .

Abstract

Background: We evaluated treatment of osteomyelitis in the foot in the presence of Charcot neuroarthropathy, a devastating condition with progressive degeneration and joint destruction. We hypothesized that there was a difference in (1) amputation rate, (2) amputation level, (3) duration of antibiotic therapy, and (4) duration of immobilization for treatment of osteomyelitis within versus outside the Charcot zone.

Methods: Forty patients (43 ft) diagnosed with Charcot neuroarthropathy and osteomyelitis of the same foot were retrospectively analyzed. Some patients were successfully treated for osteomyelitis at different sites on the same foot at different times, thus 60 cases of osteomyelitis were identified in 40 treated patients. Cases were divided according to osteomyelitis localization: Group 1 had osteomyelitis outside the active Charcot region; Group 2 had osteomyelitis within the active Charcot region.

Results: Male patients (n = 29; mean age 58.2, range 40.1 to 77.5 years) were younger than female patients (n = 11; mean age 70.4, range 51.4 to 87.5, p = 0.02 years). Amputation rate was 52% overall (26/40 patients; 26/43 ft): 63% of 30 Group 1 cases and 40% of 30 Group 2 cases (p = 0.09). Amputation level (p = 0.009), duration of antibiotic treatment (p = 0.045) and duration of immobilization (p = 0.01) differed significantly between the groups.

Conclusions: Osteomyelitis within the Charcot region is associated with a higher level of amputation and longer durations of antibiotic therapy and immobilization. Osteomyelitis outside and within the Charcot affected region should be considered separately. If osteomyelitis occurs outside the active Charcot region, primary amputation may be preferred to internal resection.

Level of evidence: Retrospective cohort chart review study.

Keywords: Amputation; Antibiotic; Charcot; Osteomyelitis; Treatment.

PubMed Disclaimer

Conflict of interest statement

Authors’ information

CB and SL are residents in orthopedic surgery; LV, TB, and MB are board-certified orthopedic surgeons; additionally, the senior authors TB and MB are specialized in the treatment of the diabetic foot.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Canton of Zurich, Switzerland (Amendment dt. 10.11.2016, positiv, BASEC 2016–00271). Written informed consent was obtained from all participants.

Consent for publication

Not required, as there are no identifying data for any individual person.

Competing interests

The authors declare that they have no potential conflicts of interest or competing interests with respect to the research, authorship, and/or publication of this article.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Histogram showing the level of amputation in Group 1 with osteomyelitis outside the Charcot region (n = 30) and in Group 2 with osteomyelitis within the Charcot region (n = 30) when treatment was successfully completed, and in the absence of recurrence of osteomyelitis
Fig. 2
Fig. 2
Histograms showing the level of amputation in relation to (a) insulin dependency (n = 35 insulin-dependent diabetes, n = 25 non-insulin-dependent diabetes) and (b) compliance with treatment for osteomyelitis and Charcot arthropathy (n = 23 compliant, n = 27 non-compliant, n = 10 not recorded)
Fig. 3
Fig. 3
The duration of antibiotic therapy in Group 1 with osteomyelitis outside the Charcot region (mean 55.7 ± 48.9 days) and in Group 2 with osteomyelitis inside the Charcot region (mean 84.1 ± 51.2 days) differed significantly (p = 0.045). In Group 1, the duration of antibiotic therapy was 43.9 days shorter in cases of initial amputation compared to cases of initial internal resection (p = 0.02). In Group 2, the duration of antibiotic therapy was similar for the different initial surgical treatments (p = 0.09). Asterisk = significant difference
Fig. 4
Fig. 4
The duration of immobilization in Group 1 with osteomyelitis outside the Charcot region (mean 83.1 ± 70.5, range 19 to 304 days) and in Group 2 with osteomyelitis inside the Charcot region (mean 144 ± 91.8, range 17 to 389 days, p = 0.01) differed significantly (p = 0.01). The duration of immobilization was similar for the different initial surgical treatments within each group. Asterisk = significant difference
See this image and copyright information in PMC

References

    1. Frykberg RG, Bevilacqua NJ, Habershaw G. Surgical off-loading of the diabetic foot. J Vasc Surg. 2010;52(3 Suppl):44S–58S. doi: 10.1016/j.jvs.2010.06.008. - DOI - PubMed
    1. Wukich DK, Sung W. Charcot arthropathy of the foot and ankle: modern concepts and management review. J Diabetes Complicat. 2009;23(6):409–426. doi: 10.1016/j.jdiacomp.2008.09.004. - DOI - PubMed
    1. Strotman PK, Reif TJ, Pinzur MS. Charcot Arthropathy of the foot and ankle. Foot Ankle Int. 2016;37(11):1255–1263. doi: 10.1177/1071100716674434. - DOI - PubMed
    1. Berendt AR, Peters EJ, Bakker K, Embil JM, Eneroth M, Hinchliffe RJ, Jeffcoate WJ, Lipsky BA, Senneville E, Teh J, et al. Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev. 2008;24(Suppl 1):S145–S161. doi: 10.1002/dmrr.836. - DOI - PubMed
    1. Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45(8):1085–1096. doi: 10.1007/s00125-002-0885-7. - DOI - PubMed

MeSH terms

Substances

LinkOut - more resources