Diabetic Nephropathy but not HbA1c is Predictive for Frequent Complications of Charcot Feet – Long-term follow-up of 164 Consecutive Patients with 195 Acute Charcot Feet

Abstract

Aims:

To investigate the clinical characteristics, treatment and long-term outcome of patients with acute Charcot feet (CF).

Methods:

Single-center retrospective analysis. Treatment of CF: stage-dependent immobilization/weight-off therapy, orthopaedic/adjusted shoes, foot surgery. 164 consecutive participants (type 1 vs. type 2 diabetes): 12 vs. 150, non-diabetic peripheral neuropathy: n=2, presented with 195 (17 vs. 176) CF. Mean follow-up: 4.7±2.5 (range 2.2–9.8) vs. 5.4±2.9 (range 0.8–18.8) years, vital at follow-up: 100 vs. 88%.

Results:

Baseline characteristics: age: 43.7±10.9 vs. 57.9±8.9 years (p<0.001), male gender: 66.7 vs. 77.3%, diabetes duration: 19.2±9.1 vs. 13±8.6 years (p=0.018), GHb: 8.1±2.4 vs. 7.6±1.6%, BMI: 24±5.3 vs. 33.7±6.5 kg/m² (p<0.001), Levine 1: 18.2 vs. 7.4%, Levine 2: 45.5 vs. 65.9%, Sanders 2: 58.3 vs. 68.5%, Sanders 3: 33.3 vs. 45%. Therapy: immobilization for 6±4.2 vs. 5.4±4.5 months, orthopaedic/adjusted shoes: 27.3 vs. 20.5%, foot surgery: 11.8 vs. 18.2%. Major complications: 50 vs. 56% (rocker bottom deformities: 23.5 vs. 46.3%, foot ulcerations: 17.6 vs. 24.6%, CF amputations: 0 vs. 6%), not CF amputations: 16.7 vs. 15.3%, second episodes of CF: 41.6 vs. 18.3% after 5–132months. Diabetic nephropathy was associated with an increase, intensive antihypertensive therapy with a decrease of complications.

Conclusions:

Patients with CF are middle-aged, overweight males with type 2 diabetes above 10 years. Patients with type 1 diabetes are younger, have normal BMI and longer diabetes duration. Major complications and second episodes of CF are frequent. Diabetic nephropathy could be a risk factor for CF related complications. The awareness for CF must be improved.

The study was conducted due to the Declaration of Helsinki.

Key words

charcot foot - neuropathic osteoarthropathy - diabetes mellitus

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