Evaluation of the prognosis of type IV Charcot arthropathy treatment

Abstract

Objective: To evaluate the prognosis of specialized orthopedic treatment to obtain a functional foot and ankle in diabetic patients with neglected Charcot arthropathy (NCA). Methods: Sixty-five patients with NCA were treated in the period between 2000 and 2017, according to a systematized protocol adopted at
our institution. Six patients (9%) were lost to follow-up, and the remaining 59 patients had a total of 63 affected extremities (four patients were bilaterally affected). The mean follow-up time was 72 months (range 12 to 132 months), and the mean age was 54 years (range 30 to 80 years). We considered the results satisfactory when the patient was able to walk independently, fully supporting the foot on the ground. We considered the results unsatisfactory when the affected extremity presented a frank instability and was deformed to the point that it was not possible to accommodate it in a stabilizing orthesis or support it during gait or when amputation was necessary. Results: We obtained an unsatisfactory result in 31 of the 59 patients (53%). Only 31 of the 63 extremities (49%) were considered functional after treatment. Conclusion: The prognosis of NCA treatment using the systematized treatment protocol is poor. Only half of the treated extremities were capable of plantar support and independent gait. Level of Evidence IV; Prognostic Studies; Case Series.