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Long-term follow-up of conservative treatment of Charcot feet
BACKGROUND: Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially be...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9474498/ https://www.ncbi.nlm.nih.gov/pubmed/33829302 http://dx.doi.org/10.1007/s00402-021-03881-5 |
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author | Gratwohl, Viviane Jentzsch, Thorsten Schöni, Madlaina Kaiser, Dominik Berli, Martin C. Böni, Thomas Waibel, Felix W. A. |
author_facet | Gratwohl, Viviane Jentzsch, Thorsten Schöni, Madlaina Kaiser, Dominik Berli, Martin C. Böni, Thomas Waibel, Felix W. A. |
author_sort | Gratwohl, Viviane |
collection | PubMed |
description | BACKGROUND: Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially being treated conservatively, and to identify risk factors for reactivation and contralateral development of CN as well as common complications in CN. METHODS: A total of 184 Charcot feet in 159 patients (median age 60.0 (interquartile range (IQR) 15.5) years, 49 (30.1%) women) were retrospectively analyzed by patient chart review. Rates of limb salvage, reactivation, contralateral development and common complications were recorded. Statistical analysis was performed to identify possible risk factors for limb loss, CN reactivation, contralateral CN development, and ulcer development. RESULTS: Major amputation-free survival could be achieved in 92.9% feet after a median follow-up of 5.2 (IQR 4.25, range 2.2–11.25) years. CN recurrence occurred in 13.6%. 32.1% had bilateral CN involvement. Ulcers were present in 72.3%. 88.1% patients were ambulating in orthopaedic footwear without any further aids. Presence of Diabetes mellitus was associated with reactivation of CN, major amputation and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations. CONCLUSIONS: With consistent conservative treatment of CN with orthopaedic footwear or orthoses, limb preservation can be achieved in 92.9% after a median follow-up of 5.2 years. Patients with diabetic CN are at an increased risk of developing complications and CN reactivation. To prevent ulcers and amputations, every effort should be made to make patients stop smoking. LEVEL OF EVIDENCE: III, long-term retrospective cohort study SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-021-03881-5. |
format | Online Article Text |
id | pubmed-9474498 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-94744982022-09-16 Long-term follow-up of conservative treatment of Charcot feet Gratwohl, Viviane Jentzsch, Thorsten Schöni, Madlaina Kaiser, Dominik Berli, Martin C. Böni, Thomas Waibel, Felix W. A. Arch Orthop Trauma Surg Orthopaedic Surgery BACKGROUND: Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially being treated conservatively, and to identify risk factors for reactivation and contralateral development of CN as well as common complications in CN. METHODS: A total of 184 Charcot feet in 159 patients (median age 60.0 (interquartile range (IQR) 15.5) years, 49 (30.1%) women) were retrospectively analyzed by patient chart review. Rates of limb salvage, reactivation, contralateral development and common complications were recorded. Statistical analysis was performed to identify possible risk factors for limb loss, CN reactivation, contralateral CN development, and ulcer development. RESULTS: Major amputation-free survival could be achieved in 92.9% feet after a median follow-up of 5.2 (IQR 4.25, range 2.2–11.25) years. CN recurrence occurred in 13.6%. 32.1% had bilateral CN involvement. Ulcers were present in 72.3%. 88.1% patients were ambulating in orthopaedic footwear without any further aids. Presence of Diabetes mellitus was associated with reactivation of CN, major amputation and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations. CONCLUSIONS: With consistent conservative treatment of CN with orthopaedic footwear or orthoses, limb preservation can be achieved in 92.9% after a median follow-up of 5.2 years. Patients with diabetic CN are at an increased risk of developing complications and CN reactivation. To prevent ulcers and amputations, every effort should be made to make patients stop smoking. LEVEL OF EVIDENCE: III, long-term retrospective cohort study SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00402-021-03881-5. Springer Berlin Heidelberg 2021-04-07 2022 /pmc/articles/PMC9474498/ /pubmed/33829302 http://dx.doi.org/10.1007/s00402-021-03881-5 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Orthopaedic Surgery Gratwohl, Viviane Jentzsch, Thorsten Schöni, Madlaina Kaiser, Dominik Berli, Martin C. Böni, Thomas Waibel, Felix W. A. Long-term follow-up of conservative treatment of Charcot feet |
title | Long-term follow-up of conservative treatment of Charcot feet |
title_full | Long-term follow-up of conservative treatment of Charcot feet |
title_fullStr | Long-term follow-up of conservative treatment of Charcot feet |
title_full_unstemmed | Long-term follow-up of conservative treatment of Charcot feet |
title_short | Long-term follow-up of conservative treatment of Charcot feet |
title_sort | long-term follow-up of conservative treatment of charcot feet |
topic | Orthopaedic Surgery |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9474498/ https://www.ncbi.nlm.nih.gov/pubmed/33829302 http://dx.doi.org/10.1007/s00402-021-03881-5 |
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