Pharmacological therapy in Charcot management

sezza · Mar 19, 2009

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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

kimharman · Mar 23, 2009

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

Admin2 · Mar 24, 2009

Related threads:
Pamidronate infusion timing in Charcot Rx
Other threads tagged with Charcot

sezza · Apr 20, 2009

Thanks Kim, very useful!

NewsBot · Aug 28, 2013

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

Acute Charcot neuroarthropathy is a devastating condition and, its incidence is increasing. Currently, treatment consists of immobilisation and off-loading of the involved extremity. Outcomes are frequently poor and novel treatments are being sought urgently. This review aims to outline advances in the pharmacological treatment of this, condition.

PubMed and the Cochrane Database of systematic reviews were searched. Relevant papers were cross referenced.

Eleven original studies were identified. The limited data available suggest pamidronate, alendronate and calcitonin provide some clinical and biochemical improvements while zoledronic acid is deleterious and, increases off-loading times. However, the data is not robust enough to convincingly demonstrate clinically meaningful effects. The studies were predominantly low quality and heterogeneous. They differed markedly in study type, pharmacological agent used, dosing regimen, disease, aetiology/stage/location, concurrent off-loading regimen, outcomes and, follow-up. Few were rigorous in controlling for associated confounding variables and none investigated long term outcomes.

The routine use of pharmacological treatment modalities for this condition is not recommended in the United States by the Food and Drug Administration or in the United Kingdom by the National Institute for Health and Clinical Excellence. Given the evidence available this is justified and further higher quality research is required.
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Pharmacological therapy in Charcot management

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Pharmacological therapy in Charcot management

sezza Member

kimharman Member

Admin2 Administrator Staff Member

sezza Member

NewsBot The Admin that posts the news.

Pharmacological interventions for the treatment of Achilles tendinopathy

Tactile Therapy Shift Patients Toward Equilibrium

Treating plantar fasciitis; American Physical Therapy Association guidelines

Testosterone replacement therapy is associated with increased odds of Achilles tendon injury

Video Based Game Exercise Therapy for Flat Feet

Use of extracorporeal shock wave therapy for children’s foot, ankle and leg concerns

Leech therapy and Ayurveda for diabetic foot ulcers

Share This Page

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