| Abstrakt: |
Charcot Neuro-Arthropathy is diagnosed on clinical grounds; typically a swollen, warm, neuropathic foot with bounding pulses, excluding other pathologies often in retrospect. Data reporting incidence and prevalence look at specialist referral-based foot clinics, little population based data is available and even less include follow-up. We address this prospectively studying incidence, prevalence and outcomes of Charcot over an 11 year period (1996-2006) within a stable population; with a validated Diabetic Register as the central data point of a district which includes an integrated foot service and centralized referral point for diabetic foot problems which links directly to the community. Charcot audit in 2001 led to a community education program highlighting etiology and treatment mechanisms, to encourage early referrals and diagnosis enabling earlier intervention. We report the natural and medical history of Charcot in this population. Results: Diabetes Mellitus (DM) increased from 7430 (1996) to 12027 (2006), the prevalence of Charcot also increased from 10.8 to 27.4 per 10,000 yet the incidence remained constant over the 11 year period; mean 3.1 per 10,000 cases. Treatment was skilful casting (38 total contact casts, 2 scotch cast boots, 2 air cast walkers). 4 limbs were amputated below knee; all others are preserved and functioning. Following community education acute referrals (<2 weeks) increased from 41% (2001) to 52% (2006) reducing the number of late referrals from 45% to 38%. Early referral led to earlier treatment with casting. Mean time in casts reduced from 8 (2001) to 5 (2006) months and reduced time from active Charcot to quiescence from 11 to 9.4 months. 75% Charcot feet successfully weaned into footwear, and 4 later died, 3 from myocardial infarcts and 1 cerebrovascular accident. Of the 9 feet that did ulcerate following weaning into bespoke footwear, 5 had exostectomies, 4 amputations and 1 death. Conclusion: Charcot Arthropathy remains rare. Early diagnosis and treatment reduces the time in cast and time to quiescence and demonstrates the need for early referral. DM patients with Charcot may have similar life expectancy to patients with DM but without Charcot. [ABSTRACT FROM AUTHOR] |
