Orthotic Treatment Prevents Most Charcot Foot Amputations

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Charcot foot can lead to limb loss despite appropriate treatment, and initial conservative treatment is the accepted treatment in case of a plantigrade foot. Researchers conducted a retrospective study to investigate the mid- to long-term clinical course of Charcot foot after conservative treatment, and to identify risk factors for reactivation and contralateral development and common complications of the condition. In a study about the findings, the authors concluded that with consistent conservative treatment of Charcot foot with orthopedic footwear or orthoses, limb preservation can be achieved in nearly all patients.

A total of 184 Charcot feet in 159 patients (median age 60 years, 30.1 percent women) were retrospectively analyzed by patient chart review at an orthopedic surgery referral center in Zurich, Switzerland. The researchers found that major amputation-free survival could be achieved in 92.9 percent of feet after a median follow-up of 5.2 years (interquartile range 4.25, range 2.2-11.25 years).

Recurrence occurred in 13.6 percent of patients, 32.1 percent had bilateral involvement, ulcers were present in 72.3 percent, and 88.1 percent of patients were ambulating in orthopedic footwear without further aids.

The presence of diabetes mellitus was associated with reactivation of Charcot foot, major amputation, and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations.

The open-access study, "Long-term follow-up of conservative treatment of Charcot feet," was published in the Archives of Orthopaedic and Trauma Surgery.