THE DIABETIC FooT

Stage 0: later added, describes the Inflammation phase, characterHistory and Etiology The earliest record of neuropathic arthropathy includes Sir William Musgrave in 1703 contributing this disease process to a complication of venereal disease. Later on, the term “Charcot Foot” was formed after the accounts of Jean-Martin Charcot in the 1880s, as he noted neuropathic arthropathy among his patients with tertiary syphilis. This was the most common etiology of the disease process but was swiftly overtaken with the increasing prevalence of diabetic peripheral neuropathy in the U.S. The prevalence of Charcot’s neuro-arthropathy (CN) has been debated in literature, ranging from 0.08% to 7.5%. In regard to diabetic patients with peripheral neuropathy, this percentage rises to 29% in some specialty clinics. While this disease is most often seen unilaterally, the prevalence of bilateral CN is not uncommon, with studies reporting up to a third of the cases. This is a debilitating disease process with a high risk of progression into severe deformity that can be limb-threatening. Currently, the accepted clinical treatment for acute CN is “prompt, uncompromis ing reduct ion in weight-bearing stress, frequent monitoring, and gradual progression to unprotected weight-bearing in prescription footwear.” While this may be done with different methods, total-contact casting has been proven to be extremely effective in achieving this goal. Recent studies as well as consensus documents favor total-contact casting for CN in terms of its efficacy in preventing further destruction of the foot structure from weight-bearing forces throughout the disease process. For the majority of foot and ankle neuropathic fractures and dislocations, the gold standard for treatment is non-surgical in nature, with the utilization of total-contact casting followed by appropriate bracing and footwear. In 2011, the ADA Consensus Statement described appropriate treatment as ‘off-loading at the acute active stage of the Charcot foot as ‘the most important management strategy’ which could arrest the progression of the deformity. “Ideally, the foot should be immobilized in an irremovable total contact cast.” In 2014, Snyder, et al. agreed with Here’s a closer look at why this is the “gold standard” for treating this condition. Total Contact Casting the Charcot Foot