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Charcot foot rehabiliation after wearing iTTC

Discussion in 'Diabetic Foot & Wound Management' started by rjames, Jul 6, 2014.

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  1. rjames

    rjames Member


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    Hi all. I generally place any diabetic patient with an acute Charcot neuroarthropathy into an instant total contact cast (pneumatic walking boot with Coban wrap to make it tamper detectable). However, once I remove the patient from the boot, there is the expected muscle atrophy and weakness of the limb. I have two questions

    1) I use the skin temperature as a marker to determine if all osteoclastic activity has ceased however, do you always need a comparison xray of the foot when you first place it in the boot and then of the foot when you think you should remove it from the boot? Can an x ray determine if all osteoclastic activity had ended or do you need a MRI/bone scan?

    2) What rehabilitation is advisable for muscle strengthening? Is there is specific program available ?

    I hope someone can point me in the right direction.

    RJ
     
  2. cwiebelt

    cwiebelt Active Member

    Hello RJ

    From what I know we go by temperature difference there should be normalisation of skin temperature between the Charcot affected foot and the unaffected foot
    Less than 2 degree Celsius temperature difference

    X rays monthly to see progress, MRI is better but more expensive and if a plain X-Ray is going to show you what you need I would go the simpler route
    MRI May be more more of a diagnostic tool

    I would progress out of a iTcc and plan for some form of custom fabricated soft supportive insole with a suitable boot, shoe

    May need to work with a good physio and rehab team to get client mobile again.
    May take some time

    Hope this helps !
    Chris
     
  3. rjames

    rjames Member

    Thank you Chris. That will help as I was not confident plain xays would give a true picture. I wondered if the rehab will be similar to anyone who may have just have a cast removed and suffering from "disuse" atrophy of muscles or if there were additional recommendations/cautions for those with a Charcot foot.

    RJ
     
  4. rjames

    rjames Member

    Thank you Chris. That will help as I was not confident plain xays would give a true picture. I wondered if the rehab will be similar to anyone who may have just have a cast removed and suffering from "disuse" atrophy of muscles or if there were additional recommendations/cautions for those with a Charcot foot.

    RJ
     
  5. cwiebelt

    cwiebelt Active Member

    Hi RJ
    There is a good article in the journal of foot and ankle research
    http://www.jfootankleres.com/content/6/1/30
    Developing an evidenced-based clinical pathway for the assessment,diagnosis and management of acute Charcot neuro-arthropathy:a systematic review
    You might find it useful
    Chris
     
  6. rjames

    rjames Member

    This review article is extremely helpful and provides a great flow chart with the management pathways. A good read and useful for anyone managing diabetic feet.Thank you again Chris.

    RJ
     
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