| Abstrakt: |
The acute Charcot foot is a rare, but serious, complication of diabetic neuropathy - which may lead to progressive deformity of the affected foot, and often to limb loss. Pathogenesis is uncertain and current therapy is mainly reliant on reduced weight bearing until the active phase of the disease remits. It is recommended that this is achieved by the use of unremovable below knee casts or walkers. There are few data available on the median time to disease remission and whether outcome is affected by other treatments, such as bisphosphonates. For this reason we set up a web-based survey of active cases of Charcot disease in the UK (CDUK), in order to define baseline characteristics, precipitating factors, management details and outcome, in as large a cohort as possible. Participating clinicians were invited to register anonymised details of patients with active disease being managed between 1st June 2005 and 31st December 2006, and further details were requested at 3-monthly intervals for 12 months. A total of 279 (73% male) cases were registered; mean age 57 years (range 21-90); 72% Type 2 diabetes. Outcome data are available for 200 patients at 3 months post registration, 142 patients at 6 mouths and 61 patients at 12 months. 61.6% were registered as having had a likely precipitating event within the 6 months prior to onset (accident 34.9%, previous ulcer 34.9%, surgery to affected foot 11.4%, osteomyelitis 6.8%). Initial management included offloading specified as non-removable below knee 36.7%, removable below knee 49.8%, non-removable foot 1.5%, removable foot 3.1% and other (eg. bed rest, crotches) 8.9%. 46.3% received treatment with intravenous (25.8%) or oral (18.9%) bisphosphonates, some in combination. 5.3% had more than one treatment with intravenous bisphosphonates. It is necessary to seek associations between intervention and outcome in order to define optimal management of this crippling complication of diabetes. [ABSTRACT FROM AUTHOR] |
