A retrospective audit of the characteristics and treatment outcomes in patients with diabetes-related charcot neuropathic osteoarthropathy

Abstract

Aims: To review the characteristics, management and outcomes one year after diagnosis in patients with diabetes related charcot neuropathic osteoarthropathy (CN) treated at the Diabetes Podiatry service, Waitemata District Health Board (WDHB) between 2000-2014.

Methods: Patients with diabetes and recorded diagnosis of CN were identified from the podiatry service records. Clinical details were retrospectively obtained from WDHB databases and patient medical records.

Results: Forty-one patients were included, 31 had type 2 diabetes, 10 had type 1 diabetes. At presentation, the median duration of all-type diabetes was 15 years. The median time from symptom onset to diagnosis was 17 weeks. Symptoms at presentation were: oedema (49%), warmth (73%), erythema (17%), swelling (90%) and pain (60%). Concomitant ulcers were present in 32%, deformities 83%, osteomyelitis 2% and septic arthritis 2%. Mean time to ambulation in modified shoes was 21.3 weeks (±11.5). Complication rates one year from diagnosis for ulcers, osteomyelitis, amputations and all-cause mortality were 34%, 2%, 2% and 5% respectively.

Conclusion: Time to diagnosis of CN was shorter than previously reported, though the high rate of deformities still suggests a significant delay in diagnosis. Increased education of healthcare professionals and people with diabetes-related neuropathy is important to ensure early diagnosis and appropriate management to reduce deformities and complications.