Ten years of Charcot: what have we learned?

NewsBot · Jun 30, 2024

Review and Evaluation of European National Clinical Practice Guidelines for the Treatment and Management of Active Charcot Neuro-Osteoarthropathy in Diabetes Using the AGREE-II Tool Identifies an Absence of Evidence-Based Recommendations
Nichola Renwick et al
J Diabetes Res. 2024 Jun 10:2024

Background: Charcot neuro-osteoarthropathy (CNO) is a rare but devastating complication of diabetes associated with high rates of morbidity; yet, many nonfoot specialists are unaware of it, resulting in missed and delayed diagnosis. Clinical practice guidelines (CPGs) have proven useful in improving quality of care and standardizing practice in diabetes and diabetic foot care. However, little is known about the consistency in recommendations for identification and management of active CNO. Aim: The aim of this study is to review European national diabetes CPGs for the diagnosis and management of active CNO and to assess their methodological rigor and transparency. Methods: A systematic search was performed to identify diabetes national CPGs across Europe. Guidelines in any language were reviewed to explore whether they provided a definition for active CNO and recommendations for diagnosis, monitoring, and management. Methodological rigor and transparency were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) tool, which comprises 23 key items organized within six domains with an overall guideline assessment score of ≥ 60% considered to be of adequate quality to recommend use. Each guideline was assessed by two reviewers, and inter-rater agreement (Kendall's W) was calculated for AGREE-II scores. Results: Seventeen CPGs met the inclusion criteria. Breadth of CNO content varied across guidelines (median (IQR) word count: 327; Q1 = 151; Q3 = 790), and 53% provided a definition for active CNO. Recommendations for diagnosis and monitoring were provided by 82% and 53%, respectively, with offloading being the most common management recommendation (88%). Four guidelines (24%) reached threshold for recommendation for use in clinical practice (≥ 60%) with the scope and purpose domain scoring highest (mean (SD): 67%, ± 23%). The remaining domains had average scores ranging between 19% and 53%. Inter-rater agreement was strong (W = 0.882; p < 0.001). Conclusions: European national CPGs for diabetes provide limited recommendations on active CNO. All guidelines showcased deficits in their methodology, suggesting that more rigorous methods should be employed for diabetes CPG development across Europe.
Click to expand...

NewsBot · Jul 25, 2024

Chronic Kidney Disease and Charcot Neuro-Osteoarthropathy of Foot in Diabetes
Jayaditya Ghosh et al
Int J Low Extrem Wounds. 2024 Jul 21

Introduction: Charcot neuro-osteoarthropathy (CNO) occurs late in diabetes and may cause fracture, deformity, and higher mortality. Diabetic kidney disease (DKD) affects bone metabolism and contributes to mortality. However, there is no data on prevalence of CNO and its outcomes with coexisting DKD (or chronic kidney disease [CKD]).

Methods: To ascertain the prevalence of CKD (pick CKD or DKD) among patients with CNO and delineate the remission of active CNO and subsequent lower extremity amputation and all-cause mortality during prospective follow-up. Consecutive patients with diabetic CNO (active or inactive) were enrolled and subsequently divided into those with and without CKD (pick CKD or DKD) (Group A and Group B, respectively). A preestablished timeframe of 36 weeks was utilized to evaluate the remission proportion of active CNO.

Results: A total of 493 CNO patients were observed and 449 subjects (150 patients had active CNO) were further evaluated. The overall prevalence of diabetic nephropathy (DKD or CKD?) CNO was 43.7%. The proportion of patients achieving remission was significantly lower in Group A compared to Group B (OR 0.468, CI [0.239-0.934], P = .025), however, the median time for achieving remission was similar between the 2 groups (14 weeks vs 16 weeks, P = .885). Overall, all-cause mortality was notably higher Group A compared to Group B (OR 2.23, 95% CI [1.474-3.368]) over a median follow-up of 4 years. No significant differences were observed in rates of diabetic foot ulcers (58.2% vs 54.9%; P = .584) and amputations (17.4% vs 15.12%; P = .889) between Group A and Group B.

Conclusion: Patients of CNO with coexisting CKD have poor prognosis both in terms of likelihood of active CNO remission and higher mortality.
Click to expand...

NewsBot · Jul 25, 2024

Assessment, diagnosis and management characteristics of people with acute Charcot neuro-osteoarthropathy in a regional Australian health service: A 3-year retrospective audit
Dimitri Diacogiorgis, Byron Matthew Perrin, Michael Ian Charles Kingsley
Aust J Rural Health. 2024 Jul 23

Objective: Acute Charcot neuro-osteoarthropathy (CN) is highly destructive, causing bone and joint damage that can result in devastating structural changes to the foot. The objective of this study was to determine the characteristics of assessment, diagnosis and management of people with acute CN attending a large regional Australian health service.

Design: Three-year retrospective medical record audit.

Setting: Large regional health service with catchment area of >250 000 people in regional Australia.

Participants: People with acute CN who attended emergency, orthopaedic clinics or High Risk Foot Clinic (HRFC).

Main outcome measures: Participant characteristics and acute CN assessment, diagnosis and management characteristics. Trends in characteristics were investigated according to rurality as measured by the Modified Monash Model (MMM) scale.

Results: Seventeen participants (20 presentations) of acute CN were identified. Mean age was 57.1 ± 10.8 years, with 11 female participants. Median duration to seek help was 31 (IQR 14-47) days. Total Contact Casting was undertaken for 85% of cases, with those who resided in MMM1-2 regions experienced significantly shorter time to TCC therapy compared to those residing in MMM3-7 regions (U = 3.0, p < 0.01). Resolution of acute CN with or without deformity occurred in 70% of cases.

Conclusions: Those who lived in smaller regional and rural communities were more likely to experience delayed access to gold standard treatment for acute CN. Regional models of care for acute CN should include activities to improve the knowledge of people at risk of acute CN about the condition and upskill regional health professionals for timely and local TCC therapy.
Click to expand...

NewsBot · Aug 21, 2024

Influence of Fractures and Dislocations in Severity of Rocker-Bottom Deformity in Patients with Charcot Foot
Raúl J Molines-Barroso et al
Int J Low Extrem Wounds. 2024 Aug 14

The objective of this study was to identify bone fractures and joint dislocations that have greater association with the severity of arch collapse in patients with Charcot foot involving the midfoot.A retrospective study in 28 (N = 29 feet) patients who had Charcot foot deformity of the midfoot. The study included stage III of Eichenholtz classification, and Schon classification types I to III. Talar-first metatarsal and calcaneal pitch angles and cuboid height were used to evaluate the severity of the midfoot deformity in a weightbearing lateral radiograph. Two investigators evaluated the bone fracture and joint dislocation involved in weightbearing antero-posterior and lateral radiographs.There were 13 (46%) feet that showed pattern 1, 9 (31%) feet with pattern 2, and 7 (25%) feet with pattern 3 according to the Schon classification. One foot had a combination of patterns 1 and 2. Midfoot ulceration occurred in 64% (n = 19) of feet. In the multivariate analysis, plantarflexion of talar-first metatarsal angle was predicted by navicular-medial cuneiform dislocation (p = .007 [-20.620-3.683]), an increase of the negative calcaneal pitch angle by fragmentation of the cuboid (p = .003 [-15.568-3.626]), and increment of the negative cuboid height by navicular-medial cuneiform and medial cuneiform-first metatarsal dislocations (p = .040 [-12.779-0.317], p = .002 [-13.437-3.267], respectively).Bone fractures and dislocations in the sagittal plane seem to contribute to midfoot collapse, but navicular-medial cuneiform dislocation/non-union and cuboid fragmentation predict severe rocker-bottom deformity in cases of Charcot foot.
Click to expand...

NewsBot · Sep 27, 2024

Risk factors for Charcot foot development in individuals with diabetes mellitus
Georgios Tsatsaris et al
Diabetologia. 2024 Sep 13

Aims/hypothesis: Charcot foot is a complication of diabetes mellitus that has potentially disastrous consequences. Although it was first described in 1868 and found to be associated with diabetes in 1936, there is still uncertainty about the risk factors affecting the development of the condition. Here, we aim to identify risk factors for Charcot foot in a nationwide cohort study.

Methods: A retrospective register-based cohort study was performed for the period 2001-2016, using nationwide registries. Individuals with diabetes and Charcot foot were identified and matched by diabetes type and with similar diabetes duration with individuals with diabetes but not Charcot foot. Logistic regression analyses were used to identify risk factors.

Results: A total of 3397 participants with diabetes mellitus and Charcot foot and 27,662 control participants with diabetes but without Charcot foot were included. HbA1c, duration of diabetes, micro- and macroalbuminuria, retinopathy and atherosclerosis (general and peripheral) were identified as risk factors for Charcot foot in participants with type 1 diabetes and participants with type 2 diabetes.

Conclusions/interpretation: In the most extensive study on Charcot foot to date, we identified distinctive and common risk factors associated with the development of Charcot foot in individuals with type 1 diabetes and type 2 diabetes.
Click to expand...

NewsBot · Sep 27, 2024

Analysis of Genetic Risk Factors Associated with Charcot Foot Based on the FinnGen Study R9 Data: A Wide-angle Mendelian Randomization Study
Sichao Jiang, Shouyu Wang
Int J Low Extrem Wounds. 2024 Sep 16

Background: Charcot foot or Charcot neuropathic joint disease (CN) is a rare and complex foot disease with unknown pathogenesis, hindering early identification and intervention. The study aimed to clarify the causal association between all predominant risk factors and CN.

Methods: Two-sample Mendelian Randomization (MR), Multivariate MR, and Bidirectional MR analyses investigated the causal association between 36 modifiable risk factors and CN. The causal relationship between CN and Inflammatory cytokine and immune cells was also analyzed.

Results: Genetic factors associated with obesity and genetic susceptibility to various autoimmune diseases and non-cancerous thyroid diseases increased the risk of CN (P < .05), genetically associated high basal metabolic rate and high total cholesterol decreased the risk of CN (P < .05). In addition, we found a bi-directional causal relationship between CN and diabetes. In further immune cell analysis, we found 8 CN related immune cells, and in inflammatory cytokine analysis, we found 2 CN related inflammatory cytokines.

Conclusions: This comprehensive MR Study supports the causal role of Obesity-related factors, diabetes, autoimmune-related factors, and smoking in the development and progression of CN. This study identifies a potential cause of CN that has not been identified in previous studies and provides a new direction for further research.
Click to expand...

NewsBot · Sep 29, 2024

Etiopathogenetic features of bone metabolism in patients with diabetes mellitus and Charcot foot
M V Yaroslavceva et al
Probl Endokrinol (Mosk). 2024 Sep 15;70(4):57-64

Diabetic neuropathy is one of the most common diabetes mellitus complications associated with mediocalcinosis of the lower extremities, a significant decrease in feet bone mineral density, and a high incidence of cardiovascular disease. In most cases, calcium-phosphorus metabolism changes occur in patients with diabetic neuroarthropathy, or Charcot foot, when we can observe feet local osteoporosis, which in 90% of cases associated with a vessel's calcification of the lower extremities in the majority of diabetes population. A large number of studies presented literature have demonstrated that patients with Charcot foot can have accelerated bone metabolism and increased bone resorption. Patients with Charcot foot often have crucial abnormalities in the calcium-phosphorus parameters, bone metabolism, and levels of vitamin D and its metabolites. In addition, the duration of diabetes mellitus, the degree of its compensation widely affects the development of its micro- and macrovascular complications, which could also accelerate the development of mineral and bone disorders in these types of patients. Multifactorial pathogenesis of these disorders complicates the management of patients with a long and complicated course of diabetes mellitus. This review discusses the peculiarities of vitamin D metabolism, the importance of timely diagnosis in phosphorus-calcium disorders, and the specifics of therapy in these patients. Special attention is paid to the timely diagnosis of the Charcot's foots acute stage based on the bone marrow edema by MRI evaluation and the possibility of reducing the immobilization period.
Click to expand...

NewsBot · Nov 6, 2024

Genetic Signature for the Causation of Charcot Neuro-osteoarthropathy of Foot in Diabetes: A Systematic Review
Sonali Sharma et al
Source

Charcot neuro-osteoarthropathy (CNO) is a complication of diabetes occurring in people with diabetic neuropathy with a prevalence of 0.5% to 1% that may culminate to foot deformity, amputation, and early mortality. However, it is not known why only certain patients with diabetic neuropathy develop CNO. Hence, early recognition of risk factors, timely diagnosis, and appropriate intervention of CNO is pertinent. Recent understanding of the pathophysiology of CNO has expanded to suggest the involvement of RANKL-OPG pathways. But pharmaco-therapeutic interventions targeting bone metabolism predominantly inhibiting RANKL were not found to be useful. Moreover, there are not enough markers to help identify patients with diabetes who are at a higher risk of developing CNO. Hence, we explored the literature in the present systematic review of mainly case-control studies to identify genetic factors that could help in understanding the pathophysiology and risk factors for the development of CNO. We could identify 7 relevant studies identifying single nucleotide polymorphism of OPG and RANK genes. There is an isolated study identifying alterations of micro RNA associated with RANKL-OPG pathway. Another study found epigenetic alterations by performing whole methylome sequencing in people with CNO compared to control. These genetic factors can be used as a diagnostic marker and their functional counterparts as targets for future therapeutic interventions. However, we found that literature is sparse on the genetic risk factors for CNO in people with diabetic neuropathy and there is still a lot of scope for future studies towards finding the molecular and genetic markers for CNO.
Click to expand...

NewsBot · Nov 6, 2024

Demographics and baseline characteristics of patients with charcot foot: a multi-center cohort analysis
Edward Jude et al
Endocrine Abstracts (2024) 99 P47 | DOI: 10.1530/endoabs.99.P47

Aims: Charcot foot (CF) is a rare complication of T2DM, progressively leads to bone deformities of the lower extremities. The aim of this study was to record baseline characteristics of patients with CF.

Patients and methods: A multicenter retrospective cohort study (n=774), including all patients diagnosed with CF from eight Diabetic Foot Clinics in 6 countries between 01/01/1996 and 31/12/2022, was performed. Data regarding duration and complications of DM, anthropometric, clinical and laboratory parameters were obtained from the medical records.

Results: Mean age of patients was 56.5±10.7 years and the mean age at CF diagnosis was 54.5±11.7 years, 70.5% were men. T2DM was more prevalent (83.2%), the mean duration of DM at diagnosis was 17.3 years and median glycated hemoglobin was 8% (Interquartile range-IQR 6.8-9.3%) at diagnosis of CF. Regarding anthropometric features, mean height, weight and body mass index (BMI) were 169.40±16.5 cm, 84.4±21.0 kg, 28.97±7.8 kg/m2, respectively. Most of the patients had hypertension (74.5%), quarter of them were active or ex-smokers (25.2%) or alcohol users (23.3) and previous medical history comprised of peripheral artery disease (19.7%), coronary artery disease (17.5%) or stroke (5.4%). Neuropathy was the most prevalent (89%) amongst the microvascular complications followed by retinopathy (60%) and nephropathy (45%). A foot ulcer was present in about half of the patients (48.5%) while CF was equally distributed between feet (right foot 49%-left foot 44%-bilateral 6.5%) and majority of them were in midfoot (65%), forefoot 18%, hindfoot 13.9% and multiple joint involvement (2.6%). Patients with type 1DM in comparison with those with T2DM were diagnosed with CF at younger age (46.9±11.0 vs 57.9±10.2 years, P<0.001), had lower BMI (26.6±6.0 vs 29.5±8.0 kg/m2, P=0.001) and longer diabetes duration [median (IQ): 29.0 (21.0-38.0) vs 14.0 (8.0-20.0) years, P<0.001]. No differences were found between T1D and T2DM in HbA1c. No significant gender differences were found in terms of age at CF diagnosis, BMI or HbA1c; however, the duration of DM at CF diagnosis was lower in men vs women 15.0 (1.0-22.0) vs 17.0 (10.0-25.0) years, P=0.037].

Conclusion: This is the largest cohort of patients with CF globally. CF is predominant in males, occurs in people with long-standing DM, is often accompanied by microvascular complications, half of patients have foot ulcers at CF diagnosis, affects equally both feet, and the more frequent location is in the midfoot. Further studies are needed to look at outcomes and mortality.
Click to expand...

NewsBot · Nov 18, 2024

Factors associated with the development of recurrent and contralateral Charcot neuroarthropathy in individuals with diabetes mellitus: A scoping review
Keet Yeng Cheong et al
J Foot Ankle Res. 2024 Dec;17(4):e70016.

Introduction: Charcot neuroarthropathy (CN) can result in fractures and dislocations of the foot and ankle in individuals with diabetes and neuropathy, leading to ulceration, amputation and a poor quality of life. Additional episodes of acute CN can lead to extended periods of physical and psychosocial distress. The aim of this scoping review was to identify and synthesise the evidence relating to factors associated with the development of recurrent and contralateral Charcot neuroarthropathy (CN) in individuals with diabetes.

Methods: A systematic search of four electronic databases was conducted from inception to February 06, 2023. All relevant study designs, except single case studies, that had been published in full in peer-reviewed journals were included. Studies were excluded if they were not published in English and did not provide data on individuals with diabetes.

Results: The search identified two studies that investigated factors associated with the development of recurrent CN, but none that related to the development of contralateral CN. Ten factors were investigated for association with recurrent CN development: age, body mass index, diabetes type and duration, glycated haemoglobin, anatomical site affected, duration of offloading applied to treat the primary CN episode, use of pharmacological intervention, severity of neuropathy, and skin temperature. However, no significant associations were reported.

Conclusions: There is an alarming lack of evidence-based findings in this research area to guide practice. Clearly, more research in the form of rigorous prospective studies is urgently required to identify risk factors for the development of recurrent and contralateral CN in individuals with diabetes.
Click to expand...

Ten years of Charcot: what have we learned?

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Predictors and persistence of foot problems in women aged 70 years and over

Tibialis anterior tendon insertion variations in relation to hallux valgus

The Training Intensity Distribution of Marathon Runners

Shoelace tension when running

Healthcare-Seeking Intention Questionnaire in Diabetic High-Risk Foot

Rothbart Proprioceptive Insoles attenuate Scoliotic curves

Extensor Retinaculum Syndrome of the Ankle

Share This Page

Ten years of Charcot: what have we learned?

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Predictors and persistence of foot problems in women aged 70 years and over

Tibialis anterior tendon insertion variations in relation to hallux valgus

The Training Intensity Distribution of Marathon Runners

Shoelace tension when running

Healthcare-Seeking Intention Questionnaire in Diabetic High-Risk Foot

Rothbart Proprioceptive Insoles attenuate Scoliotic curves

Extensor Retinaculum Syndrome of the Ankle

Share This Page

Useful Searches