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Incidence and management of ulcers in diabetic Charcot feet.
J Wound Care. 2001 Sep; 10(8):323-8.JW

Abstract

This study followed 115 patients with diabetes--who between them had 140 feet with Charcot's arthropathy--over six to 114 months (median: 48). A total of 43 patients (37%) developed ulcers in 53 feet. Their treatment was multifactorial. An offloading regimen was adopted, with the use of crutches and therapeutic sandals with soft, individually moulded insoles, followed by adjusted or bespoke shoes. Recalcitrant ulcers were treated with surgery in 16 patients (37%). Antibiotics were needed by 21 patients (49%). The incidence of ulceration was 17% per year. The median time interval between the acute component of Charcot's arthropathy and ulcer development was 36 months (range: 0-120 months). In seven patients, the ulcer developed during the acute phase. In 12 patients the ulcers were localised to the rockerbottom deformity in the mid-foot region, but in 31 patients other regions were affected. Dynamic footprint analysis was used to help adjust the offloading shoe/insole on the rockerbottom deformity. Such ulcers took twice as long to heal as other ulcers. Surgical treatment comprised: major amputation (two patients), arthrodesis for unstable ankle (three patients), toe amputations (seven patients), resection of the rockerbottom deformity (one patient) and other revisions (three patients). One patient died with an unhealed ulcer. There is a four-fold risk of ulcers in diabetic Charcot deformity compared with the overall risk of foot ulcers in diabetic feet. Healing was achieved in 40 patients (93%). The surgical intervention rate of 37% in ulcer cases in Charcot feet was low compared with the literature.

Authors+Show Affiliations

Diabetes Centre, Copenhagen, Denmark.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12964335

Citation

Larsen, K, et al. "Incidence and Management of Ulcers in Diabetic Charcot Feet." Journal of Wound Care, vol. 10, no. 8, 2001, pp. 323-8.
Larsen K, Fabrin J, Holstein PE. Incidence and management of ulcers in diabetic Charcot feet. J Wound Care. 2001;10(8):323-8.
Larsen, K., Fabrin, J., & Holstein, P. E. (2001). Incidence and management of ulcers in diabetic Charcot feet. Journal of Wound Care, 10(8), 323-8.
Larsen K, Fabrin J, Holstein PE. Incidence and Management of Ulcers in Diabetic Charcot Feet. J Wound Care. 2001;10(8):323-8. PubMed PMID: 12964335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence and management of ulcers in diabetic Charcot feet. AU - Larsen,K, AU - Fabrin,J, AU - Holstein,P E, PY - 2003/9/11/pubmed PY - 2003/10/11/medline PY - 2003/9/11/entrez SP - 323 EP - 8 JF - Journal of wound care JO - J Wound Care VL - 10 IS - 8 N2 - This study followed 115 patients with diabetes--who between them had 140 feet with Charcot's arthropathy--over six to 114 months (median: 48). A total of 43 patients (37%) developed ulcers in 53 feet. Their treatment was multifactorial. An offloading regimen was adopted, with the use of crutches and therapeutic sandals with soft, individually moulded insoles, followed by adjusted or bespoke shoes. Recalcitrant ulcers were treated with surgery in 16 patients (37%). Antibiotics were needed by 21 patients (49%). The incidence of ulceration was 17% per year. The median time interval between the acute component of Charcot's arthropathy and ulcer development was 36 months (range: 0-120 months). In seven patients, the ulcer developed during the acute phase. In 12 patients the ulcers were localised to the rockerbottom deformity in the mid-foot region, but in 31 patients other regions were affected. Dynamic footprint analysis was used to help adjust the offloading shoe/insole on the rockerbottom deformity. Such ulcers took twice as long to heal as other ulcers. Surgical treatment comprised: major amputation (two patients), arthrodesis for unstable ankle (three patients), toe amputations (seven patients), resection of the rockerbottom deformity (one patient) and other revisions (three patients). One patient died with an unhealed ulcer. There is a four-fold risk of ulcers in diabetic Charcot deformity compared with the overall risk of foot ulcers in diabetic feet. Healing was achieved in 40 patients (93%). The surgical intervention rate of 37% in ulcer cases in Charcot feet was low compared with the literature. SN - 0969-0700 UR - https://www.unboundmedicine.com/medline/citation/12964335/Incidence_and_management_of_ulcers_in_diabetic_Charcot_feet_ L2 - https://www.magonlinelibrary.com/doi/10.12968/jowc.2001.10.8.26113?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -