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Review
. 2024 Dec 16:12:20503121241306957.
doi: 10.1177/20503121241306957. eCollection 2024.

Weight bearing versus non-weight bearing total contact cast in the management of active Charcot foot: A systematic review

Rachna Prem  1 , Vikramman Vignaraja  2 , Thomas Lewis  2 , Basil Budair  3
Affiliations
Review

Weight bearing versus non-weight bearing total contact cast in the management of active Charcot foot: A systematic review

Rachna Prem et al. SAGE Open Med. .

Abstract

Aim: Diabetic Charcot neuro-osteoarthropathy carries a significant worldwide disease burden including diabetic foot infection, ulceration and amputation. The current accepted standard of treatment during the active phase of Charcot neuro-osteoarthropathy is offloading with total contact casting; however, controversy remains regarding weight-bearing status during this period.

Methods: A systematic review was performed following PRISMA guidelines of Pubmed, EMBASE, MEDLINE and the Cochrane central register of controlled trials for clinical studies from inception until June 2024 investigating weight-bearing and non-weight-bearing total contact casting for active Charcot neuro-osteoarthropathy.

Results: Four hundred ninety-three studies were identified in the search strategy of which 5 studies met the inclusion criteria comprising 158 patients. These studies found that allowing patients to weight-bear during total contact casting does not have a negative impact on the healing process. There were no comparative studies between weight-bearing and non-weight-bearing total contact casting.

Conclusions: There is limited evidence to support current practice of non-weight bearing in a total contact casting for active Charcot neuro-osteoarthropathy. Allowing patients to weight bear carries advantages to patient independence and quality of life. Further investigation with randomised control trial should be considered to investigate if weight bearing is associated with negative outcomes.

Keywords: Charcot neuroarthropathy; casting; deformity; diabetes; diabetic foot; diabetic foot ulceration; offloading; total-contact-casting; weight-bearing.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. No conflicts in data handling.

Figures

Figure 1.
Figure 1.
(a) AP X-ray of Charcot foot showing destruction along the Tarso-metatarsal joints and (b) lateral weight-bearing X-ray of Charcot foot showing late stage rocker-bottom deformity.
Figure 2.
Figure 2.
PRISMA flow chart showing identification of studies.
Figure 3.
Figure 3.
ROBINS-I tool showing levels of bias in the included papers.
See this image and copyright information in PMC

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