Introduction/Purpose: There are limited data in the literature regarding natural history of Charcot Neuroarthropathy (CN) of the foot and ankle. The utility of a classification system should be threefold: accurately describe the disease process, guide the appropriate treatment, and predict the long-term prognosis. This study investigates the natural history of CN of foot and ankle, and whether the Anatomic Classification is predictive of outcome and prognosis.
Methods: A retrospective review of 334 patients treated at a single institution by a single surgeon from January 1986 to June 2010 was conducted. Clinical records, imaging studies, and operative reports were reviewed to tabulate the Anatomic Classification type, patient demographics (age, gender, BMI, diabetes, RA), number and types of surgeries performed, location of surgery, initial and final job status, ulcer status, ambulatory status and shoe wear type. ANOVA and Pearson Chi square were utilized to assess whether the classification was predictive of variables. P-values of < 0.05 were considered statistically significant.
Results: Outcomes/p-values are listed in table 1.
35.3% of patients presented with a unilateral Type 1 Charcot foot(n=118), 17.1% presented with a unilateral Type 2(n=57), 13.8% presented with a unilateral Type 3(n=46), and 33.8% presented with bilateral disease(n=113).
CN due to RA had increased bilateral involvement(12.4%; 14/113) compared to unilateral involvement(5%,11/221)(p=0.026).
Comparing bilateral versus unilateral Types 1,2,or 3, a similar trend was noted(p=0.0939).
The Anatomic classification predicted location/need for surgical intervention(p < 0.00001).
The classification predicted distal disease was associated with increased likelihood to require shoe-wear modifications(p=0.0001). While a statistically significant difference was not detected, a trend for the classification to predict persistent ulceration at final follow-up was noted. Patients with bilateral involvement and more distal disease were more likely to have ulceration(p=0.0968).
Conclusion: While the Anatomic classification did not predict ambulatory status, and only trended towards statistical significance for ulceration at the time of final follow-up, there is utility in the classification system for predicting location of surgery as well as shoe-wear at final follow-up. Additionally, patients with CN due to RA had an increased likelihood of having bilateral foot involvement. The Anatomic Classification has clinical utility when counseling patients on the overall course of their disease process.
Click to expand...