Journal Article

Audit of acute Charcot’s disease in the UK: the CDUK study

Catlow, R., Rayman, G., Edmonds, M. E., Game, F. L., Jeffcoate, W. J., Jones, G. R., Jude, E. B.

2012

Overview

Aims/hypothesis We studied factors associated with the development and resolution of acute Charcot foot using a web-based observational study. Methods Clinicians managing cases of acute Charcot foot in the UK and Ireland between June 2005 and February 2007 were invited to register anonymised details on a secure website. Results A total of 288 cases (age 57.0 ± 11.3 years [mean ± SD]; 71.2% male) were registered from 76 centres. Of these, 36% of patients recalled an episode of relevant trauma in the preceding 6 months, while 12% had had surgery to the affected foot. In 101 (35%) cases, ulceration was present at registration and 20% of these had osteomyelitis. Non-removable off-loading devices were used at presentation in 35.4% of cases, with removable off-loading used in 50%. Data on resolution were available for 219 patients. The median time to resolution was 9 months in patients whose initial management included the use of non-removable off-loading, compared with 12 months in the remainder ( p  = 0.001). Bisphosphonates were administered intravenously in 25.4% and orally in 19.4% of cases. The median time to resolution in patients who received bisphosphonates was 12 months and was longer than in those who did not (10 months, p  = 0.005). Conclusions/interpretation The median time to resolution was longer than in earlier series. Although limited by being observational and non-randomised, these data suggest that the use of non-removable off-loading at presentation may shorten the time to resolution. They provide no evidence to indicate that the use of bisphosphonates is beneficial.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Arthropathy, Neurogenic - complications / Arthropathy, Neurogenic - drug therapy / Arthropathy, Neurogenic - etiology / Arthropathy, Neurogenic - therapy / Associated diseases and complications / Biological and medical sciences / Bisphosphonates / Bones / Cohort Studies / Diabetes / Diabetes. Impaired glucose tolerance / Diabetic Foot - complications / Diabetic Foot - drug therapy / Diabetic Foot - etiology / Diabetic Foot - therapy / Diphosphonates - therapeutic use / Diseases of the osteoarticular system / Endocrine pancreas. Apud cells (diseases) / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Female / Follow-Up Studies / Foot diseases / Fractures / Hospitals / Human Physiology / Humans / Inflammation / Internal Medicine / Internet / Ireland - epidemiology / Male / Medical sciences / Medicine / Medicine & Public Health / Metabolic Diseases / Middle Aged / Miscellaneous. Osteoarticular involvement in other diseases / Observational studies / Orthopedic Equipment - adverse effects / Osteomyelitis - complications / Postoperative Complications - drug therapy / Postoperative Complications - epidemiology / Postoperative Complications - etiology / Postoperative Complications - therapy / Practice Patterns, Physicians / Registration / Short Communication / Surgery / Trauma / Ulcers / United Kingdom - epidemiology / Wounds and Injuries - physiopathology / Young Adult