Can Bracing Have An Impact For The Charcot Foot?

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Author(s): 
Alan Banks, DPM, FACFAS

   Figure 5 (right) shows a quiescent sagittal plane Charcot deformity and good stability. The patient wore a double upright brace. Four years later, there had been no progression of deformity and the osseous structures had further consolidated in the midfoot.

When There Is Bilateral Charcot Deformity

What about patients with bilateral Charcot deformity? I have employed bracing in this scenario via one of two means depending upon the severity of deformity and other patient specific concerns. If one employs more traditional bracing, then use a double upright brace for the foot deemed most at risk and a single lateral upright on the contralateral limb. Patients with a double upright brace on each limb may have a higher risk of falling if the medial struts impact each other with weightbearing.

   However, one may employ two double upright braces if the deformity is such that the medial brace can be closely aligned with the medial ankle and leg. Alternatively, one could use a CROW walker on each side.

In Conclusion

Bracing can provide a viable option to improve function and reduce risk in many patients with Charcot deformity. If this modality has not been an integral part of your practice, you might consider calling a local prosthetist and meeting him or her to exchange thoughts and institute a referral relationship.

   Dr. Banks is in private practice at Village Podiatry Centers in Tucker, Ga. He is board certified in Foot and Ankle Surgery, and is a Diplomate of the American Board of Podiatric Surgery. He is a faculty member of the Podiatry Institute and a Fellow of the American College of Foot and Ankle Surgeons. Dr. Banks was the chief editor of the third edition of McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery.

References
1. Kitaoka HB, Crevoisier XM, Harbst K, Hansen D, Kotajarvi B, Kaufman K. The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces. Arch Phys Med Rehabil. 2006; 87(1):130-135.
2. Landsman AS, Sage R. Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis. J Am Podiatr Med Assoc. 1987; 87(8):349-57.
3. Saltzman CL, Johnson KA, Goldstein RH, Donnelly RE. The patellar tendon-bearing brace as treatment for neurotrophic arthropathy: a dynamic force monitoring study. Foot Ankle. 1992; 13(1):14-31.
4. Raikin SM, Parks GBG, Noll KH, Schon LC. Biomechanical evaluation of the ability of casts and braces to immobilize the ankle and hindfoot. Foot Ankle Int. 2001; 22(3):214-219.

   For further reading, see “A Guide To Bracing For Charcot” in the June 2004 issue of Podiatry Today, “Point-Counterpoint: Active Charcot: Should You Proceed With Surgery?” in the March 2005 issue, “Emerging Evidence On Treatment Of The Diabetic Charcot Foot” in the March 2012 issue, “Reassessing The Impact Of Diabetic Footwear” in the March 2004 issue or “A Closer Look At Fixation Options For The Charcot Foot” in the November 2005 issue.

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Frank Caruso, CO/LOsays: March 19, 2013 at 9:42 am

Great article by Dr. Banks. I've been practicing orthotics and prosthetics over 30 years. I work with many Charcot patients. I currently work at wound care center clinics in my existing practice in Tennessee.

The CROW has its disadvantages. I have been using a device known as TORCH, which is a true problem solver and patients and docs appreciate the results. TORCH is made by American Orthopedics (Mount Vernon, NY) with a cast and a completed detailed instruction form. It is a type of boot made out of any leather color with an AFO built into it. Different types of closures may be used so you don't have constant repadding issues for adjustments. You can have all your buildups and partial foot and/or custom orthotics built right into the TORCH. Patients can have a matching shoe for the opposite side. Patient compliance is better.

I've also been using American's new patented dynamic suspension AFO known as the Revolution for some Charcot and other foot and ankle conditions. I have gotten excellent results and can share patient videos for both Revolution and TORCH. The controlled motion in the Revolution brace allows improved functional outcomes and addresses gait in all three planes unlike traditional AFOs. Leather gauntlets lock the calcaneus.

I recommend that podiatry, orthopedics and therapy offices try some of the new innovations in bracing to include in their care and treatment plan. I do a lot of teaching and courses across the country. I spoke in Orlando to a podiatry group just a couple of weeks ago. The doctors in attendance were very impressed with the bracing and techniques I use in my clinical practice. I would be more than happy to offer advice to any one to help improve lives and cost of healthcare. fbcaru1@comcast.net

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