The consequences of complacency: managing the effects of unrecognized Charcot feet

Abstract

Several authors have discussed an early prodromal state of neuroarthropathy (stage 0 Charcot) prior to the development of frank radiographic changes. However, very few reports are available that detail the outcomes of these patients. The purpose of this study was to report on the outcomes of patients with undetected early Charcot neuroarthropathy of the foot. Twenty patients, from two health science centres, were diagnosed retrospectively with stage 0 Charcot neuroarthropathy and were managed after referral from outside facilities. We evaluated any complications, including ulcer formation, infection, progression into active Charcot neuroarthropathy and the need for surgical reconstruction. Patients who did not progress to an active Charcot neuroarthropathy (Group I) were compared with those (Group II) who did progress to the destructive phase. The diagnosis of Charcot neuroarthropathy was missed in 19 of 20 patients prior to referral. The average delay in treatment in Group I was 4.1±0.7 weeks compared with 8.7±6.8 weeks in Group II (Mann-Whitney U-test=24.5, n(1) =15, n(2) =7, P<0.05 two-tailed). Sixteen of 22 feet (72%) developed a complication during their treatment course. Group II experienced more complications than Group I (66.7% compared with 14.3%). Overall, eleven of 22 feet (50%) required surgical treatment; however, no patient required an amputation during the follow-up course. This study reveals that outcomes of stage 0 Charcot neuroarthropathy feet depend on proper recognition and early management. To reduce the rate of future complications for Charcot foot should be the goal of all treatment.