A research team found that evidence supporting the use of orthoses in the prevention and treatment of diabetic foot ulcers secondary to Charcot arthropathy was extremely limited. They therefore conducted a study to find evidence supporting a difference in complication rates and progression of Charcot deformity between two interventions: the Charcot Restraint Orthotic Walker (CROW) and the custom calf lacer AFO.
Subjects diagnosed with diabetes mellitus and Charcot arthropathy and referred for orthotic treatment were considered. A billing audit of those treated between September 1, 2018, and May 1, 2020, was generated using codes L-2330 and L-4631. Subjects were excluded if they received a midfoot or higher amputation before application of the offloading device. In total, 87 charts were retrospectively reviewed, and 47 people were included.
Results showed that no significant difference was found in complication rate between the two groups. The first year of orthotic intervention had the highest number of complications for both devices. In addition, most calf lacer subjects wore the orthosis for two to three years, whereas most CROW subjects wore the orthosis for two years.
The researchers concluded that the findings suggested that both orthotic interventions available to treat diabetic foot ulcers secondary to Charcot arthropathy have similar complication rates, and more research is needed to determine the clinical benefits of prescribing one intervention over the other.
Although evidence suggested lower complication rates with the use of calf lacer AFO, this study found no statistical difference in the overall number of complications observed with the two orthotic interventions, the study’s authors wrote.
