Total contact cast for Charcot's

NewsBot · Apr 1, 2008

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Charcot Arthropathy and Immobilization in a Weight-Bearing Total Contact Cast
Leo J. de Souza
The Journal of Bone and Joint Surgery (American). 2008;90:754-759.

Background: The standard management for Eichenholtz Stage-I Charcot arthropathy has been with non-weight-bearing total contact casts. The purpose of this study was to evaluate the results of the use of weight-bearing total contact casts for similar patients.

Methods: Twenty-seven patients with Charcot arthropathy of the foot and ankle were studied prospectively over a period of eighteen years, from 1988 to 2006. The average duration of follow-up was 5.5 years. Of the twenty-seven patients, twenty-six had diabetes mellitus. Total contact casts were used to treat thirty-four feet with Eichenholtz Stage-I or early Stage-II Charcot arthropathy. These patients were allowed to bear weight as tolerated. Casts were changed at weekly intervals and were worn until resolution of the acute stage of the disease.

Results: No deleterious effect from weight-bearing, specifically with regard to skin ulceration or rapid deterioration of the osseous architecture, was observed in thirty-three of the thirty-four feet.

Conclusions: Immobilization in a weight-bearing total contact cast appears to be a safe method of treatment of acute Eichenholtz Stage-I Charcot arthropathy of the foot and ankle.
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NewsBot · Dec 17, 2008

Treatment of Charcot foot and ankle with a prefabricated removable walker brace and custom insole.
Verity S, Sochocki M, Embil JM, Trepman E.
Foot Ankle Surg. 2008;14(1):26-31

BACKGROUND: Removable walker braces have been used successfully to treat acute and chronic foot and ankle conditions including diabetic foot ulcers. We hypothesized that a removable walker brace may be successfully used in the management of the Charcot foot and ankle.

METHODS: Twenty-five feet and ankles with Charcot arthropathy in 21 patients (bilateral in 4 patients) were treated with a prefabricated, pneumatic removable walker brace fitted with a custom orthotic insole. Follow-up data were collected from patient interview, examination, and radiography.

RESULTS: Brace fitting was accomplished usually with a single visit to the prosthetist or pedorthist/orthotist. At the most recent evaluation, 17 (68%) feet and ankles had consolidation (stage III) of the Charcot arthropathy (average duration of brace use, 29+/-19 weeks) and were subsequently treated with rocker sole shoes, insoles, and ankle foot orthoses; 8 (32%) feet and ankles had ongoing brace treatment. Three feet developed new deformity during brace treatment, but average radiographic parameters of hindfoot to forefoot alignment had minimal change between initial and final radiographs at an average of 36+/-24 weeks after initial radiographic evaluation.

CONCLUSIONS: The prefabricated, pneumatic removable walker brace fitted with a custom insole was successful in the management of the Charcot foot and ankle and had a high satisfaction rate and safety profile despite frequent, albeit usually minor, complications.
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NewsBot · Jun 17, 2014

Utilization Rates of Various Offloading Modalities for Charcot Foot in a Large Managed Care Network
JAMES WROBEL, NIDHI TALWAR, KEIKO ASAO, JOSHUA STEIN
Presented at the 74th American Diabetes Association Mtg; San Francisco; June 14-17 2014

The objective was to describe offloading approaches used in practice for the treatment of Charcot foot (CN) in a large managed care network.

The Clinformatics DataMart database (OptumInsight, Eden Prairie, MN) contains detailed records of all beneficiaries in a managed care network across the United States. The dataset contains demographics, socioeconomic status, medical claims, laboratory data, and outpatient pharmacy claims for all beneficiaries receiving care from 2001 through 2011.

In patients with diabetes, we identified 8,785 individuals carrying ≥1 Charcot foot diagnosis (CN) (ICD-9-CM 713.5x) during 2001-11. In the CN group, 4,947 (56%) received offloading treatment other than custom or orthopedic shoes. In the treated group, the most recommended treatment total contact casts were applied in only 604 (12.2%) of patients. Removable cast walking boots were used in 2,337 (47.2%) of patients and Charcot Restraint Orthotic Walker (CROW) was used in 2,006 (40.5%) patients. The Venn diagram (Figure 1) shows 210 unique patients (4.2%) treated with total contact casts exclusively.

Total contact casts are considered the gold standard for treating CN. We found very low utilization rates (4.2-12.2%) of total contact cast treatment. Our findings are consistent with others describing very low utilization of total contact casts for treating diabetes-related foot ulcers.
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NewsBot · Dec 23, 2014

Full contact plaster cast for conservative treatment of Charcot foot.
Trieb K, Ramadani F, Hofstaetter SG.
Orthopade. 2014 Dec 16.

BACKGROUND:
The gold standard for treatment of early stages of Charcot foot are immobilization with a full contact plaster cast, whereby different periods and loading concepts are described in the literature.
OBJECTIVES:
The etiology, disease course and preparation for an early conservative therapy are described and a key point is a full contact plaster cast.
METHODS:
An overview of the etiology, pathogenesis and indications for correct evaluation of the wound situation is given. The correct technique for the total cast is described and illustrated step by step with pictures.
RESULTS:
If treatment of Charcot foot is initiated in the early stages prevention or healing of ulcers can be achieved; therefore, the correct indications and technique are necessary and the cast should be changed periodically which is a key point of the healing process. Healing results in a reduction of redness, temperature and swelling which should be measured and documented.
CONCLUSIONS:
Treatment of Charcot foot by full contact cast and immobilization should be initiated as soon as possible.
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NewsBot · May 23, 2015

Serial casting for reconstruction of a deformed charcot foot: a case report.
Rosenblum JI, Weiss S, Gazes M, Amit-Kohn M
Wounds. 2015 May;27(5):E7-E11.

INTRODUCTION:
Charcot neuroarthropathy may occur in patients with peripheral neuropathy who do not notice pain while their bones and joints collapse or breakdown under the constant pressure of body weight. This can lead to ulcerations from severe deformity and potentially limb-threatening and life-threatening infections. Current treatments vary from immobilization to extensive reconstructive surgical interventions.
METHODS:
Serial casting, used to correct many pediatric deformities while bones are often more pliable, was used with a 63-year-old male patient who presented with an active phase of Charcot foot with ulceration. The patient previously underwent foot reconstruction and had all hardware removed prior to serial casting. Due to the potential pliability of the bones, serial casting was attempted to reform the shape and position of the foot in a reverse Ponseti-type serial casting to create a more stable structure with less deformity that could lead to epithelial breakdown.
RESULTS:
The patient regained full ambulation with a plantargrade foot and no wounds, and was followed without complications for 36 months.
CONCLUSION:
Serial weekly casting was an effective modality for treatment of this patient's Charcot foot deformity.
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NewsBot · Jun 15, 2021

Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study
Danielle A. Griffiths & Michelle R. Kaminski
Journal of Foot and Ankle Research volume 14, Article number: 44 (2021)

Background
Charcot neuroarthropathy (Charcot foot) is a highly destructive joint disease of the foot and ankle. If there is delayed diagnosis and treatment, it can lead to gross deformity, instability, recurrent ulceration and/or amputation. Total contact casting (TCC) is a treatment commonly used to immobilise the foot and ankle to prevent trauma, further destruction and preserve the foot structure during the inflammatory phase. At present, there is limited Australian data regarding the duration of TCC treatment for resolution of acute Charcot foot, and whether there are any patient and clinical factors affecting its duration. Therefore, this study aimed to address these deficiencies.

Methods
This study presents a retrospective analysis of 27 patients with acute Charcot foot attending for TCC treatment at a high-risk foot service (HRFS) in a large metropolitan health network in Melbourne, Australia. Over a three-year period, data were retrospectively collected by reviewing hospital medical records for clinical, demographic, medical imaging and foot examination information. To explore between-group differences, independent samples t-tests, Mann-Whitney U tests, Chi-square tests, and/or Fisher’s exact tests were calculated depending on data type. To evaluate associations between recorded variables and duration of TCC treatment, mean differences, odds ratios (OR) and 95% confidence intervals were calculated.

Results
Mean age was 57.9 (SD, 12.6) years, 66.7% were male, 88.9% had diabetes, 96.3% had peripheral neuropathy, and 33.3% had peripheral arterial disease. Charcot misdiagnosis occurred in 63.0% of participants, and signs and symptoms consistent with acute Charcot foot were present for a median of 2.0 (IQR, 1.0 to 6.0) months prior to presenting or being referred to the HRFS. All participants had stage 1 Charcot foot. Of these, the majority were located in the tarsometatarsal joints (44.4%) or midfoot (40.7%) and were triggered by an ulcer or traumatic injury (85.2%). The median TCC duration for resolution of acute Charcot foot was 4.3 (IQR, 2.7 to 7.8) months, with an overall complication rate of 5% per cast. Skin rubbing/irritation (40.7%) and asymmetry pain (22.2%) were the most common TCC complications. Osteoarthritis was significantly associated with a TCC duration of more than 4 months (OR, 6.00). Post TCC treatment, 48.1% returned to footwear with custom foot orthoses, 25.9% used a life-long Charcot Restraint Orthotic Walker, and 22.2% had soft tissue or bone reconstructive surgery. There were no Charcot recurrences, however, contralateral Charcot occurred in 3 (11.1%) participants.

Conclusions
The median TCC duration for resolution of acute Charcot foot was 4 months, which is shorter or comparable to data reported in the United Kingdom, United States, Europe, and other Asia Pacific countries. Osteoarthritis was significantly associated with a longer TCC duration. The findings from this study may assist clinicians in providing patient education, managing expectations and improving adherence to TCC treatment for acute Charcot neuroarthropathy cases in Australia.
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