Emerging Evidence On Treatment Of The Diabetic Charcot Foot

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Lee C. Rogers, DPM, and Robert G. Frykberg, DPM, MPH

1. Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. J Am Podiatr Med Assoc. 2011;101(5):437-446.
2. Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Diabetes Care. 2011;34(9):2123-2129.
3. Rogers LC, Bevilacqua NJ. The diagnosis of Charcot foot. Clin Podiatr Med Surg. 2008;25(1):43-51.
4. Armstrong DG, Lavery LA. Monitoring healing of acute Charcot’s arthropathy with infrared dermal thermometry. J Rehabil Res Dev. 1997;34(3):317-321.
5. Rogers LC, Bevilacqua NJ. Imaging of the Charcot foot. Clin Podiatr Med Surg. 2008;25(2):263-274.
6. Frykberg RG, Mendeszoon E. Management of the diabetic Charcot foot. Diabetes Metab Res Rev. 2000;16(Suppl 1):S59-65.
7. Jude EB, Selby PL, Burgess J, et al. Bisphosphonates in the treatment of Charcot neuroarthropathy: a double-blind randomised controlled trial. Diabetologia. 2001;44(11):2032–2037.
8. Pitocco D, Ruotolo V, Caputo S, et al. Six-month treatment with alendronate in acute Charcot neuroarthropathy: a randomized controlled trial. Diabetes Care. 2005;28(5):1214–1215
9. Game FL, Catlow R, Jones GR, et al. Audit of acute Charcot’s disease in the UK: the CDUK study. Diabetologia. 2012;55(1):32-35.
10. Bem R, Jirkovska A, Fejfarova V, et al. Intranasal calcitonin in the treatment of acute Charcot neuroosteoarthropathy. Diabetes Care. 2006;29(6):1392-4.
11. Khanna D, Arnold EL, Pencharz JN, et al. Measuring process of arthritis care: the Arthritis Foundation’s quality indicator set for rheumatoid arthritis. Semin Arthritis Rheum. 2006;35(4):211-237.
12. Bevilacqua NJ, Rogers LC. Surgical management of Charcot midfoot deformities. Clin Podiatr Med Surg. 2008;25(1):81-94.
13. Rogers LC, Bevilacqua NJ, Frykberg RG, Armstrong DG. Predictors of postoperative complications of Ilizarov external ring fixators in the foot and ankle. J Foot Ankle Surg. 2007;46(5):372-375.

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Dr.Jose Alberto Rivera Zenteno MD says: March 1, 2012 at 4:26 pm

Thanks for all of this information.
Now we can be up to date about it.


Jose Alberto Rivera, MD
Mexican Geriatric Doctor

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Dr.Sunil V.Karisays: March 8, 2012 at 7:30 am

Charcot neuroarthropathy in DM has to be detected very early to prevent further disaster.
At our diabetic limb salvage center, Ihave a protocol for detecting Charcot early.

1. Every diabetic is advised on an exercise schedule only after confirming bone and joint deformities on AP/ LAT (dynamic) X-ray views of the feet. This is done every six months and three monthsfor low risk feet and high risk feet respectively. This costs about $4, which is economical and my patients can afford. This protocol has helped many patients to arrest the pathophysiology of active Charcot.

2. The task force has not considered the Charcot changes in DFI managed for a long duration. The prevention and treatment aspects of this condition are really challenging than the active / inactive Charcots. This is common in asian contries as DFI in PNP is common and management is poor.

We plan AP/LAT (dynamic) X-ray views of the feet every month for all DFI patients in whom we have planned release of tarsal tunnel. It concludes on radiological healing and helps me to detect Charcot changes.

3. Osteomyelitis of navicular bone or medial cuniform bone alone in diabetes has led to charcot changes. This issue has to be addressed .

4. I have been practicing medical management for Charcot and limb salvage is very satisfactory.

As we practice evidence-based medicine, we always take blood sugar as evidence for DM management, Similarly, every diabetic should be advised exercise only after having an evidence that his or her feet bone architecture is normal to walk, run, jog, etc.


Dr. Sunil V.Kari, MS
Consultant Surgeon
Diabetic Foot Surgeon
Sou Mandakini Memorial Hospital
Diabetic Limb Salvage Center

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