Acute Charcot arthropathy in patients with diabetes mellitus: healing times by foot location

Abstract

Foot deformity and lower extremity dysfunction are debilitating complications of diabetes mellitus which often lead to significant permanent disability. Acute diabetic neuroarthropathy (Charcot arthropathy) directly leads to foot deformity, subsequent lower-extremity complications and may lead to lower-extremity amputation, if not identified and managed appropriately. The purpose of this study is to report the healing times of acute-onset neuropathic arthropathies (fractures, joint subluxations or dislocations) in individuals with diabetes mellitus by foot location using the ambulatory method of total-contact casting (TCC). In addition, the identification of critical subject characteristic which influence healing outcomes were determined. The results indicate all (100%) of the acute (Charcot) fractures, subluxations, or dislocations healed in an average of 86+/-45 days. Acute Charcot arthropathies of the ankle, hindfoot, or midfoot take longer to heal by TCC than arthropathies localized to the forefoot. Adherence to partial weight bearing with assistive devices during casting and early institution of cast immobilization are critical factors associated with shorter healing times using TCC. Physicians, rehabilitation specialists and third-party payers should be aware of the length of time required to heal acute Charcot foot arthropathies at all locations of the foot using TCC.