Key Considerations In Managing The Charcot Foot
Emphasizing Early Detection And Patient Education
Treatment for the neuroarthritic joint can be taxing on both the physician and the patient as a significant time commitment is required of both parties. Patient education plays a major role in reaching an appropriate treatment plan and the desired outcome. The physician must alert the patient of the time involvement in healing both conservative and surgical treatment methods. One must also address external factors with patients and incorporate them within the overall treatment regimen. One cannot overemphasize the importance of early detection of Charcot arthropathy and appropriate offloading/immobilization. A thorough exam includes a detailed patient history. When evaluating patients with neuropathy, clinicians should pay particular attention to noting any pain and swelling in the absence of a portal for infection. Clinical evaluation should include a neurologic examination, vascular examination and dermal thermometry, all of which provide important diagnostic indicators in support of the diagnosis. In particular, thermometry enables the clinician to monitor healing and facilitate progressive treatment from immobilization to shoegear. After making a diagnosis, appropriate offloading (i.e., total contact casting or TCC) will often allow for resolution of the active Charcot event.4 When a TCC is not available, employing removable cast boot walkers may be equally effective for offloading the foot. Appropriate radiographic and clinical follow-up will determine full healing. Researchers have also shown that medical management via the use of bisphosphonates is effective in the early arrest of active Charcot joints, and serves as a viable adjunctive therapy in this population.5 Although the resulting deformities of Charcot can be destructive, only 5 to 25 percent of patients with Charcot require surgical intervention.4,6 When anticipating surgical management of the Charcot foot, it is important to allow an appropriate period of patient education, planning, offloading and edema control. One must establish and confirm vascular integrity in patients prior to surgical correction. Confirming an external support structure is also important in order to optimize a patient’s ability to comply with postoperative needs and demands, and increase the possibility of a successful surgical outcome.