Researchers in Spain assessed the biomechanical characteristics of the feet of patients with Charcot neuro-osteoarthropathy and their reulceration rates before and after custom orthotic treatment and found that custom orthoses are an effective treatment option, preventing ulcers and complications that can lead to surgery. The study was published online July 31 in the Journal of the American Podiatric Medical Association.
A longitudinal prospective study was performed with 35 patients who had Charcot foot. Although some patients had a history of ulcers, at the study outset no patient had ulcers. All of the patients underwent biomechanical testing and a radiographic study. The researchers produced a “radiophotopodogram” by superimposing an imprint of the sole of each participant’s foot on a plantar radiograph. Based on the results of the tests, an orthopedic insole was prepared and therapeutic footwear prescribed for each foot. The following variables were compared between the Charcot and unaffected feet: previous ulcers and ulcer sites, reulcerations produced after treatment, type of foot (neuropathic/neuroischemic), ankle mobility, first ray mobility, and relaxed calcaneal stance position. Treatment efficacy was determined by comparing ulcers presenting in patients in the year leading up to the study period and the year in which treatment was received.
In a one-year period, 70 feet received orthotic treatment, of which 41 were Charcot feet. Ulceration rates before the study were 73.2 percent in feet with Charcot’s and 31.0 percent in those without. After one year of wearing the customized orthoses, rates fell to 9.8 percent in the Charcot feet and to zero in the feet without this condition.