Charcot arthropathy and quality of life

NewsBot · Feb 13, 2008

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Health related quality of life in patients with Charcot arthropathy of the foot and ankle
Michael P. Sochocki, Shawn Verity, Pamela J. Atherton, Jefrey L. Huntington, Jeff A. Sloan, John M. Embil and Elly Trepman
Foot and Ankle Surgery; Volume 14, Issue 1, 2008, Pages 11-15

Background
Clinical observation suggests that Charcot arthropathy of the foot and ankle has major negative consequences on the quality of life of neuropathic patients, particularly those with diabetes. We hypothesized that the quality of life in patients with Charcot arthropathy may be aggravated by Aboriginal ethnicity and rural residence because of limited access to timely specialty healthcare.

Methods
Sixty patients with Charcot arthropathy were interviewed with the Short Form 36 (SF-36) Health Survey.

Results
Mean Physical Component Summary (PCS) score was 31 ± 8 points and mean Mental Component Summary (MCS) score was 45 ± 10 points. Mean PCS and MCS scores were not affected by gender, ethnicity, residence, or Charcot stage. Mean PCS score was significantly lower in non-employed (unemployed or retired) than employed patients and in patients who did not use alcohol than those who used alcohol; MCS score was not affected by employment status or alcohol use.

Conclusions
Charcot arthropathy has a major negative effect on quality of life. The SF-36 survey was sensitive to the physical effects, but not to mental effects, of Charcot arthropathy.
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Admin2 · Feb 13, 2008

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admin · Feb 7, 2009

MORTALITY RISK OF CHARCOT ARTHROPATHY COMPARED TO DIABETIC FOOT ULCER AND DIABETES ALONE
Min-Woong Sohn, Todd A. Lee, Rodney M. Stuck, Robert G. Frykberg and Elly Budiman-Mak
Diabetes Care Publish Ahead of Print published online ahead of print February 5, 2009

Objective: To compare mortality risks of patients with Charcot arthropathy to those with diabetic foot ulcer and those with diabetes alone (no ulcer or Charcot arthropathy).

Research design and methods: A retrospective cohort of 1,050 patients with incident Charcot arthropathy in 2003 in a large healthcare system was compared to patients with foot ulcer and those with diabetes alone. Mortality was determined during a 5-year follow-up period. Charcot arthropathy patients were matched to individuals in the other two groups using propensity score matching based on patient age, sex, race, marital status, diabetes duration, and diabetes control.

Results: During follow-up 28.07% of the sample died; 18.8% with diabetes only and 37.0% with foot ulcer died compared to 28.3% with Charcot arthropathy. Multivariable Cox regression shows that, compared with Charcot arthropathy, foot ulcer was associated with 35% higher mortality risk (HR =; 1.35; 95% CI, 1.18 – 1.54) and diabetes alone with 23% lower risk (HR = 0.77; 95% CI, 0.66 – 0.90). Of the Charcot arthropathy patients, 63% experienced foot ulceration before or after the Charcot onset. Stratified analyses suggest that Charcot arthropathy is associated with significantly increased mortality risk independent of foot ulcer and other co-morbidities.

Conclusions: Charcot arthropathy was significantly associated with higher mortality risk than diabetes alone and with lower risk than foot ulcer. Foot ulcer patients tended to have higher prevalence of peripheral vascular disease and macrovascular diseases than Charcot arthropathy patients. This may explain the difference in mortality risks between the two groups.
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NewsBot · Oct 19, 2009

Long-term outcome and quality of life in patients with Charcot foot
Toni-Karri Pakarinen, Heikki-Jussi Laine, Heikki Mäenpää, Pentti Mattila and Jorma Lahtela
Foot and Ankle Surgery; Volume 15, Issue 4, December 2009, Pages 187-191

Background
There is only sparse scientific data about the long-term effects of the Charcot foot on patients’ lives and the clinical outcome. This study evaluates the long-term effects of diabetic Charcot foot.

Methods
A cross-sectional follow-up study of consecutive series of patients with Charcot foot referred to the University Hospital Diabetic Foot and Ankle Clinic between 1991 and 2002.

Results
Forty-one patients were referred with Charcot foot between 1991 and 2002. After an average follow-up of 8 years their overall mortality rate was 29% (12/41) and 29 patients (30 Charcot feet) have been followed more than 5 years. Sixty-seven percent of Charcot feet suffered at least one episode of ulceration and 50% (15/30) of affected feet had surgical treatment resulting in 29 operations. Simple exostectomy was successful in 62% of cases. The need for surgical management increased markedly 4 years after the diagnosis. Correct diagnosis within 3 months resulted in better functional outcome (AOFAS) and walking distance (p = 0.006 and p = 0.008, respectively). Lower SF-36 component scores in physical functioning, social functioning and general health perceptions were found when the study population was compared to the general population and chronically ill control subjects.

Conclusions
Diabetic Charcot foot decreases patient's physical functioning and general health but does not usually affect mental health. Surgical management is often required with an increase 4 years post-diagnosis. A delay of diagnosis of more than 3 months was found to adversely affect the quality of life and functional outcome.
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NewsBot · Mar 22, 2014

High levels of anxiety and depression in diabetic patients with Charcot foot
Zahra Chapman, Charles Matthew Shuttleworth and Jörg Wolfgang Huber
Journal of Foot and Ankle Research 2014, 7:22 doi:10.1186/1757-1146-7-22

Background/aims: Charcot foot is a rare but devastating complication of diabetes. Little research is available on the mental health impact of Charcot foot. Aim of the study is to assess mental health in diabetes patients with Charcot foot and to investigate the moderating effects of socio-demographic factors. The severity of the problem will be statistically evaluated with the help of a reference data set.

Methods
Cross-sectional questionnaire data using the Hospital Anxiety and Depression Scale (HADS) and demographic background were collected from 50 patients with diabetes and Charcot complications (males 62%; mean age 62.2 +/- 8.5 years). Statistical comparisons with a large data set of general diabetes patients acting as a point of reference was carried out.

Results
Anxiety and depression levels were high, (anxiety and depression scores 6.4 +/- 4, and 6.3 +/- 3.6 respectively). Females reported more severe anxiety and depression. Ethnic minorities and patients out of work reported more severe anxiety. Comparisons with published HADS data indicate that diabetes patients with Charcot foot experience more serious levels of anxiety and depression.

Conclusions
The high levels of mental health problems which were found in this study in diabetes patients with Charcot foot require recognition by researchers and clinicians. The findings imply the need to screen for mental health problems in diabetes patients with Charcot foot and other serious foot complications.
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NewsBot · Oct 27, 2014

Coronary artery disease as an independent predictor of survival in patients with type 2 diabetes and Charcot neuro-osteoarthropathy.
Bergis D, Bergis PM, Hermanns N, Zink K, Haak T.
Acta Diabetol. 2014 Oct 26.

AIMS:
Charcot neuro-osteoarthropathy (CN) is a rare complication of diabetic foot syndrome associated with chronic inflammation of the foot and severe, limb-threatening musculoskeletal deformities. Aim of this study was to investigate patients with CN for comorbidities, amputations, ulcers, secondary diseases and mortality.
METHODS:
The study was conducted at a specialized German hospital for patients with diabetes. One-hundred and eleven patients were enrolled, and their course was followed over a period of 15 years. Association of CN with comorbidity, foot ulcers, amputations and mortality was assessed. Clinical course of patients was followed using two standardized questionnaires.
RESULTS:
Presence of CN was significantly associated with diabetic retinopathy (p = 0.047), plantar (p < 0.001), tarsal (p = 0.032) and middle-foot ulcers (p = 0.01). A significant correlation between the presence of CN and a history of amputations was seen (p = 0.022). Patients were at increased risk to suffer from subsequent amputations during follow-up when micro- and macrovascular comorbidities such as retinopathy (p = 0.01) and peripheral artery disease (p < 0.001) were present. Additionally, coronary artery disease (CHD) was identified as an independent predictor of mortality in the cohort of this study (OR 6.192, 95 % CI 1.155-33.208, p = 0.033). Median overall survival of patients with CN and CHD was significantly shorter than OS of patients without CHD (7.8 vs. 13.1 years, p = 0.0045, HR 2.8437, 95 % CI 0.9818-8.2364).
CONCLUSIONS:
In our study, CHD was the most important factor of survival in CN patients. For optimal management of CN, adequate diagnostics and treatment of CHD according to current guidelines should be considered.
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NewsBot · Apr 4, 2018

Improvement in Quality of Life Following Operative Correction of Midtarsal Charcot Foot Deformity.
Kroin E et al
Foot Ankle Int. 2018 Mar 1:107110071876213

BACKGROUND:
Patients with Charcot foot arthropathy report a poor quality of life following the development of deformity. Their quality of life is often not improved with "successful" historic accommodative treatment. There is increased current interest in operative correction of the acquired deformity with the stated goals of achieving both the traditional goals of resolution of infection and limb salvage as well as the desire to improve quality of life. The Short Musculoskeletal Functional Assessment (SMFA) outcomes instrument appears to be a valid tool for evaluating this complex patient population.

METHODS:
Twenty-five consecutive patients undergoing operative reconstruction for nonplantigrade midtarsal Charcot foot arthropathy completed the SMFA patient-reported outcomes instrument prior to surgery, with 24 completing it at 1 year following the surgery. One patient died during the year following surgery from unrelated causes.

RESULTS:
There was an 11.5-point (95% confidence interval [CI]: -19.7 to -3.2) decrease in the standardized functional index ( P = .01). Similarly, there was a 12.4-point (95% CI: -22.5 to -2.3) decrease in the standardized bother index ( P = .02). The standardized daily activity index demonstrated a 19.6-point decrease (95% CI: -30.5 to -8.6, P = .002), and there was a 14.7-point (95% CI: -24.1 to -5.3) decrease in the standardized emotion index ( P = .004). There was no meaningful change in the standardized arm/hand index ( P = .81).

CONCLUSION:
The results of this investigation demonstrate that successful operative reconstruction of midtarsal Charcot foot arthropathy improved quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity to the modern interest in operative correction to allow the use of commercially available therapeutic footwear.
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NewsBot · Oct 3, 2018

Improvement in Quality of Life Following Surgical Correction of Midtarsal Charcot Foot Deformity
Michael Pinzur, MD, Ellen Kroin, MD
AOFAS Annual Meeting 2018 1

Introduction/Purpose: Patients with Charcot Foot Arthropathy objectively report a poor quality of life following the
development of deformity. It has recently been demonstrated that their quality of life is not improved with historic
accommodative treatment. The recent interest in surgical reconstruction of the acquired deformity is directed at improving
quality of life in addition to traditional goals of resolution of infection and limb retention. The Short Musculoskeletal Functional
Assessment (SMFA) has been proven to be a valid tool for evaluating this complex patient population.
Methods: Twenty-five consecutive patients undergoing surgical reconstruction for non-plantigrade midtarsal charcot foot
arthropathy completed the SMFA patient reported outcomes instrument prior to surgery, with twenty-four completing it at one
year following the surgery. One patient died during the year following surgery due to unrelated causes.
Results: There was an 11.47 (95% CI: -19.70 to -3.23) point decrease in the standardized functional index. (p = .01) Similarly,
there was a 12.38 (95% CI: -22.48 to -2.29) point de-crease in the standardized bother index. (p = .02) There was a 19.58 (95%
CI: -30.53 to -8.63) point decrease in the standardized daily activity index. (p = .002), and there was an 14.68 (95% CI: -24.06 to -
5.31) point decrease in the standardized emotion index (p = .004). There was no meaningful change in the standardized arm/hand
index. (p = .81)
Conclusion: The results of this investigation demonstrate that successful surgical reconstruction of midtarsal Charcot Foot
Arthropathy substantially improves quality of life. This supports the modern paradigm shift from immobilization during the active
phase of the disease process followed by simple accommodation of the acquired deformity, to the modern approach of surgical
correction to allow the use of commercially-available therapeutic footwear.
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