Audit of acute Charcot’s disease in the UK: the CDUK study

• Published in: Diabetologia Vol. 55; no. 1; pp. 32 - 35
• Main Authors: Game, F. L., Catlow, R., Jones, G. R., Edmonds, M. E., Jude, E. B., Rayman, G., Jeffcoate, W. J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 2012; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Arthropathy, Neurogenic - complications; Arthropathy, Neurogenic - drug therapy; Arthropathy, Neurogenic - etiology; Arthropathy, Neurogenic - therapy; Associated diseases and complications; Biological and medical sciences; Bisphosphonates; Bones; Cohort Studies; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic Foot - complications; Diabetic Foot - drug therapy; Diabetic Foot - etiology; Diabetic Foot - therapy; Diphosphonates - therapeutic use; Diseases of the osteoarticular system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Foot diseases; Fractures; Hospitals; Human Physiology; Humans; Inflammation; Internal Medicine; Internet; Ireland - epidemiology; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Observational studies; Orthopedic Equipment - adverse effects; Osteomyelitis - complications; Postoperative Complications - drug therapy; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - therapy; Practice Patterns, Physicians; Registration; Short Communication; Surgery; Trauma; Ulcers; United Kingdom - epidemiology; Wounds and Injuries - physiopathology; Young Adult; United Kingdom > UK; Ireland; Neuro-osteoarthropathy; Bisphosphonates; Charcot foot; Diabetic foot; Endocrinopathy; Audit; Skin disease; Nervous system diseases; Diabetic Foot; Diabetes mellitus; Disease of the foot; Diseases of the osteoarticular system; Arthropathy
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-011-2354-7

Aims/hypothesis We studied factors associated with the development and resolution of acute Charcot foot using a web-based observational study. Methods Clinicians managing cases of acute Charcot foot in the UK and Ireland between June 2005 and February 2007 were invited to register anonymised details on a secure website. Results A total of 288 cases (age 57.0 ± 11.3 years [mean ± SD]; 71.2% male) were registered from 76 centres. Of these, 36% of patients recalled an episode of relevant trauma in the preceding 6 months, while 12% had had surgery to the affected foot. In 101 (35%) cases, ulceration was present at registration and 20% of these had osteomyelitis. Non-removable off-loading devices were used at presentation in 35.4% of cases, with removable off-loading used in 50%. Data on resolution were available for 219 patients. The median time to resolution was 9 months in patients whose initial management included the use of non-removable off-loading, compared with 12 months in the remainder ( p  = 0.001). Bisphosphonates were administered intravenously in 25.4% and orally in 19.4% of cases. The median time to resolution in patients who received bisphosphonates was 12 months and was longer than in those who did not (10 months, p  = 0.005). Conclusions/interpretation The median time to resolution was longer than in earlier series. Although limited by being observational and non-randomised, these data suggest that the use of non-removable off-loading at presentation may shorten the time to resolution. They provide no evidence to indicate that the use of bisphosphonates is beneficial.