Current Insights On Classifying Charcot Arthropathy
The goal of any classification system should be to improve communication between physicians and help them identify and communicate risk to patients and their families. An ideal classification system provides important clinical information to assist in establishing appropriate treatment options and setting reasonable goals in treatment. Such a system may also serve as a prognostic tool to predict outcomes.
If one diagnoses Charcot arthropathy early in the acute phase and treats it appropriately, one can avert major deformity. However, a delay in diagnosis and treatment results in worsening outcomes. Continued trauma to an insensate foot leads to extensive bone damage, resulting in a severe, unstable deformity.
The aforementioned classification schemes are helpful in understanding the evolution and anatomic patterns of destruction. However, early recognition is most important in the overall treatment of these patients. One should closely monitor and immobilize any patient with neuropathy who presents with even a minor foot and ankle injury. Successful outcomes largely depend on the early recognition.
Appropriate treatment is based on the acuteness of the symptoms, the pattern of destruction, the presence of ulcerations and soft tissue or bone infection.23 If conservative therapy fails or if patients present with an unstable foot or ankle, surgical intervention is indicated. Surgical correction and stabilization can be effective in preventing further deformity and ulcer recurrence.
Dr. Bevilacqua is an attending surgeon within the Section of Foot and Ankle Surgery/Amputation Prevention Center at Broadlawns Medical Center in Des Moines, Iowa.
Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. He is a Fellow of the American College of Foot and Ankle Surgeons.
Editor’s note: For related articles, see “A Closer Look At Redefining Charcot” in the August 2006 issue, “Point-Counterpoint: Active Charcot: Should You Proceed With Surgery?” in the March 2005 issue, or “Current Concepts In Treating Acute Charcot’s Arthropathy” in the September 2006 issue.