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Pharmacological therapy in Charcot management

Discussion in 'Diabetic Foot & Wound Management' started by sezza, Mar 19, 2009.

  1. sezza

    sezza Member


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    Hello,
    I am doing some research into:
    - role of bone turnover markers in monitoring Charcot progression/consolidation etc
    - the use of bisphosphonates in Charcot foot
    - the use of calcitonin therapy in Charcot foot

    I have read this thread: 'Pamidronate infusion timing in Charcot Rx' , and have also read a majority of the literature on these areas.

    I was wanting to get some feedback on people's clinical experience in these areas, how things are done in your hospital etc.
    Particularly:
    - do you regularly monitor bone turnover markers as an indicator of Charcot progression? If so, which markers? How often? etc. Any evidence you can provide would be much appreciated

    - do you routinely use bisphosphonates in Charcot foot? If so, which drug and what is the dosing regime?

    - any experience with use of Calcitonin in Charcot foot? Any comparison between effectiveness of Calcitonin vs Bisphosphonates?

    I am trying to put together a proposal for the use of Bisphosphonates in Charcot foot, but there aren't many good RCT's out there.
    Any info/thoughts/ideas would be greatly appreciated.
    Cheers, Sezza
     
  2. kimharman

    kimharman Member

    Pamindronate has gone out of fashion a bit in UK as seems to delay the healing process by dampening down osteoblastic activity - some two months longer from what Fran Game at the Nottingham foot ulcers trial unit with Wm Jeffcoate found with CDUK a web based audit tool collecting info on some 200 charcot patients in GB.
    Strontium is said to help but have not seen anything published.
    Mike Edmonds at Kings college hospital London UK has done some work on bone markers.
    Both folk are approachable so ask for their advice - you may change your plans as some work has been done before and may show your proposition to be unethical!?
    Kim
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. sezza

    sezza Member

    Thanks Kim, very useful!
     
  5. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A Surgeon's guide to advances in the pharmacological management of acute Charcot neuroarthropathy
    Shafic Said Al-Nammari, Theologis Timothy, Sabokbar Afsie
    Foot and Ankle Surgery; Available online 27 August 2013
     
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