Ischemic Charcot foot

NewsBot · Sep 5, 2013

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Ischemic Charcot foot: different disease with different treatment?
Palena LM, Brocco E, Ninkovic S, Volpe A, Manzi M.
J Cardiovasc Surg (Torino). 2013 Oct;54(5):561-6.

Aim: Aim of the study was to describe the presence of peripheral arterial disease in combination with Charcot neuroarthropathy in diabetic patients, and to evaluate the role of revascularization supporting surgical and orthopedic treatment.

Methods: We retrospectively collected and analyzed data of all diabetic patients affected by Charcot neuroarthropathy in combination with critical limb ischemia, which arrived to our care for the presence of foot lesions and underwent endovascular revascularization, followed by surgical and orthopedic treatment between January 2010 and January 2012. The primary end point was to assess the limb salvage rate. The secondary end point was to evaluate the healing time of the lesions.

Results: Ten diabetic patients (10 men; mean age 69.1±8.5 years), affected by ischemic Charcot neuroarthropathy underwent endovascular revascularization, surgical debridement and orthopedic correction. The limb salvage rate was 90%, avoiding major amputation in 9 patients. In one patient (10%) the infection could not be controlled and below-the-knee amputation was carried out. The required time to heal the lesion was in mean 197.4±22.4 days, after revascularization, surgical and orthopedic treatment.

Conclusion: Patients with Charcot foot deformity can be affected by critical limb ischemia and revascularization therapy is necessary, to support surgical and orthopedic treatment, avoiding amputation and leading to limb and foot salvage.
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Admin2 · Sep 6, 2013

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NewsBot · Mar 26, 2016

Prevalence of Peripheral Arterial Disease in Patients With Diabetic Charcot Neuroarthropathy
Dane K. Wukich, MD, Katherine M. Raspovic, DPM, Natalie C. Suder, MPH
JFAS; Article in Press

Charcot neuroarthropathy (CN) is a serious complication of diabetes mellitus (DM) that can lead to pedal ulceration, infection, hospitalization, and amputation. Peripheral arterial disease (PAD) is also found in patients with diabetic foot disease; however, its prevalence in patients with CN has not been extensively evaluated. The aim of the present study was to evaluate the prevalence of PAD in a group of patients with CN (with and without ulceration) and compare this to a group of patients with diabetic foot ulceration (DFU) and no CN. We compared the lower extremity noninvasive arterial testing results of 85 patients with DM and CN with those from a group of 126 patients with DFU and no CN. No statistically significant differences were found in age, gender, type of DM (1 versus 2), insulin use, duration of DM, or history of dialysis between our study and control groups. The prevalence of PAD in the patients with CN was 40%. Compared with patients with DFUs, the patients with CN were less likely to have PAD (odds ratio 0.48, 95% confidence interval 0.28 to 0.85; p = .0111), ischemia (odds ratio 0.33, 95% confidence interval 0.16 to 0.69; p = .0033), or the need for revascularization (odds ratio 0.27, 95% confidence interval 0.10 to 0.73; p = .0097). Critical limb ischemia (great toe pressure <30 mm Hg) was 82% less likely in patients with CN than in patients with DFU. PAD in patients with CN is not uncommon; however, ischemia and the need for revascularization were significantly less likely than in patients with DFU without CN.
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NewsBot · Nov 14, 2022

The Neuro-Ischaemic Charcot Foot: Prevalence, Characteristics and Severity of Peripheral Arterial Disease in Acute Charcot Neuro-Arthropathy
Marco Meloni et al
J Clin Med. 2022 Oct 22

The study aimed to evaluate the prevalence, characteristics and outcomes of patients affected by Charcot neuro-arthropathy (CN) and peripheral arterial disease (PAD) compared to CN without PAD. Consecutive patients presenting with an acute CN were included. The sample size was calculated by the power analysis by adopting the two-tailed tests of the null hypothesis with alfa = 0.05 and a value of beta = 0.10 as the second type error and, therefore, a test power equal to 90%. Seventy-six patients were identified. Twenty-four patients (31.6%) had neuro-ischaemic CN; they were older (66 vs. 57yrs), p = 0.03, had a longer diabetes duration (19 vs. 14yrs), p < 0.001, and more cases of end-stage-renal-disease (12.5 vs. 0%), p = 0.04 and ischaemic heart disease (58.3 vs. 15.4%), p < 0.0001 than neuropathic CN. Fifty patients (65.8%) had concomitant foot ulcers, 62.5% and 67.3% (p = 0.3), respectively, in CN with and without PAD. Neuro-ischaemic CN show arterial lesions of 2.9 vessels, and PAD was located predominantly below-the-knee (75%) but not below-the-ankle (16.7%). The outcomes for neuro-ischaemic and neuropathic CN patients were, respectively: wound healing (86.7 vs. 94.3%), p = 0.08; minor amputation (25 vs. 7.7%), p = 0.003; major amputation (8.3 vs. 1.9%), p = 0.001; hospitalization (75 vs. 23%), p = 0.0001. The study showed a frequent association between CN and PAD, leading to a neuro-ischaemic Charcot foot type. Neuro-ischaemic CN leaded to an increased risk of minor and major amputation and hospitalization, compared to neuropathic CN.
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