Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 10 , ISSUE S1 ( August, 2023 ) > List of Articles

REVIEW ARTICLE

Conservative Management of Diabetic Charcot Foot: A Narrative Review

Alphy C Philips, Praneeth Divi, Inderjit Singh, Abhishek Kini

Keywords : Ankle arthritis, Charcot neuroarthropathy, Diabetes mellitus, Diabetic foot complication, Diabetic foot disease, Immobilization, Midfoot Charcot's, Offloading

Citation Information :

DOI: 10.5005/jp-journals-10040-1309

License: CC BY-NC 4.0

Published Online: 03-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aims and background: Diabetic neuroarthropathy leads to a loss of sensation in the feet due to peripheral neuropathy. This loss of sensation leads to eventual ulceration and damage to the weight-bearing surfaces of the foot. Charcot's foot, once diagnosed, should be tackled at the earliest. There exist multiple modes of conservative management. This study aims to establish the role of conservative management in patients diagnosed with Charcot's foot in the early stages by exploring the various current conservative modes of management, identifying their pros and cons, and the desired outcomes. Materials and methods: A PubMed search was performed on the date of submission of this article using the key terms of Charcot, arthropathy, neuroarthropathy, conservative management, total contact casting (TCC), bisphosphonates, calcitonin, and receptor activator of nuclear factor κ-β ligand (RANKL) inhibitors. All the studies cited here were reviewed, and the studies that reported on the conservative management of Charcot's foot were included. Results: The primary modality of treatment centers around a basic offloading and immobilization principle using TCC, and walkers where appropriate. Additionally, bisphosphonates, calcitonin, and RANKL inhibitors can be used as adjuncts in the therapy of the early stages of Charcot's neuroarthropathy. Conclusion: Charcot neuroarthropathy is a difficult early diagnosis as patients are pain-free, and hence patients once diagnosed, should be started with the appropriate methods of treatment at the earliest to avoid further progression of the disease, the need for surgical intervention and to improve the prognosis of the patient. Patients should also be educated about the necessity of microcellular rubber footwear, regular examination of their feet, and adequate glycemic control. Clinical significance: To provide a comprehensive overview of conservative management of diabetic Charcot neuroarthropathy, including the treatment options available and the benefits of each technique.


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