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The online version of this article (doi:10.1186/1757-1146-6-30) contains supplementary material, which is available to authorized users.
The authors have no relevant conflict of interest to disclose.
TM conceived, designed, performed literature search, quality assessments, contributed to discussion, wrote and reviewed/edited the manuscript. JR conceived, designed, performed quality assessments, contributed to the discussion, and reviewed/edited the manuscript. EK, HM, PL, TQ performed quality assessments, contributed to discussion and reviewed/edited the manuscript. FB designed, contributed to discussion and reviewed/edited the manuscript. All authors have read and approved the final manuscript.
Charcot Neuro-Arthropathy (CN) is one of the more devastating complications of diabetes. To the best of the authors’ knowledge, it appears that no clinical tools based on a systematic review of existing literature have been developed to manage acute CN. Thus, the aim of this paper was to systematically review existing literature and develop an evidence-based clinical pathway for the assessment, diagnosis and management of acute CN in patients with diabetes.
Electronic databases (Medline, PubMed, CINAHL, Embase and Cochrane Library), reference lists, and relevant key websites were systematically searched for literature discussing the assessment, diagnosis and/or management of acute CN published between 2002-2012. At least two independent investigators then quality rated and graded the evidence of each included paper. Consistent recommendations emanating from the included papers were then fashioned in a clinical pathway.
The systematic search identified 267 manuscripts, of which 117 (44%) met the inclusion criteria for this study. Most manuscripts discussing the assessment, diagnosis and/or management of acute CN constituted level IV (case series) or EO (expert opinion) evidence. The included literature was used to develop an evidence-based clinical pathway for the assessment, investigations, diagnosis and management of acute CN.
This research has assisted in developing a comprehensive, evidence-based clinical pathway to promote consistent and optimal practice in the assessment, diagnosis and management of acute CN. The pathway aims to support health professionals in making early diagnosis and providing appropriate immediate management of acute CN, ultimately reducing its associated complications such as amputations and hospitalisations.
Additional file 1: Search strategies.(DOC 25 KB)13047_2013_570_MOESM1_ESM.doc
Additional file 2: Level II evidence.(DOC 31 KB)13047_2013_570_MOESM2_ESM.doc
Additional file 3: Level III-IV evidence.(DOC 112 KB)13047_2013_570_MOESM3_ESM.doc
Additional file 4: Level EO evidence.(DOC 192 KB)13047_2013_570_MOESM4_ESM.doc
Authors’ original file for figure 113047_2013_570_MOESM5_ESM.pdf
Rogers LC, Frykberg RG, Armstrong DG, Boulton AJM, Edmonds M, Van Ha G, Hartemann A, Game F, Jeffcoate W, Jirkovska A, Jude E, Morbach S, Morrison WB, Pinzur M, Pitocco D, Sanders L, Wukich DK, Uccioli L: The Charcot Foot in Diabetes. Diabetes Care. 2011, 34 (9): 2123-2129. 10.2337/dc11-0844. CrossRefPubMedPubMedCentral
Leung HB, Ho YC, Wong WC: Charcot foot in Hong Kong Chinese diabetic population. Hong Kong Med J. 2009, 15 (3): 191-195. PubMed
National Evidence-Based Guideline on Prevention: Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes). 2011, Melbourne Australia
NHMRC: A guide to the development, implementation and evaluation of clinical practice guidelines. 1999, Australia: National Health and Medical Research Council
Wraight PR, Lawrence SM, Campbell DA, Colman PG: Creation of a multidisciplinary, evidence based, clinical guideline for the assessment, investigation and management of acute diabetes related foot complications. Diabet Med. 2004, 22: 127-136. CrossRef
Baglioni P, Malik M, Okosieme OE: Acute Charcot foot. BMJ. 2012, 344 (1397): 1-4.
Petrova NL, Edmonds ME: Charcot neuro-osteoarthropathy – current standards. Diabetes Metab Res Rev. 2008, 24 (Suppl 1): 58-61. CrossRef
McIntosh A, Peters J, Young R, Hutchinson A, Chiverton R, Clarkson S, Foster A, Gadsby R, O’Connor M, Rayman G, Feder G, Home PD: Prevention and Management of Foot Problems in Type 2 diabetes: clinical guidelines and evidence. 2003, Sheffield: University of Sheffield
Jeffcoate WJ: Charcot neuro-osteoarthropathy. Diabetes Metab Res Rev. 2008, 24 (Suppl 1): 62-65. CrossRef
Pakarinen TK, Laine HJ, Honkonen SE, Peltonen J, Oksala H, Lahtela J: Charcot arthropathy of the diabetic foot.: current concepts and review of 36 cases. Scand J Surg. 2002, 91: 195-201. PubMed
Bitsch M, Saunte DM, Dall C, Holstein PE: Charcot’s arthropathy following digital amputation in the diabetic foot. Foot Ankle Surg. 2003, 9: 217-220. 10.1016/S1268-7731(03)00094-8. CrossRef
Moura-Neto A, Fernandes TD, Zantut-Wittmann DE, Trevisan RO, Sakaki MH, Santos ALG, Nery M, Parisi MCR: Charcot foot: skin temperature as a good clinical parameter for predicting disease outcome. Diabetes Res Clin Pract. 2012, 96: 11-14. 10.1016/j.diabres.2011.12.029. CrossRef
Samann A, Pofahl S, Lehmann T, Voigt B, Victor S, Moller F, Muller UA, Wolf G: 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. Exp Clin Endocrinol Diabetes. 2012, 120: 335-339. CrossRefPubMed
Christensen TM, Gade-Rasmussen B, Pedersen LW, Hommel E, Holstein PE, Svendsen OL: Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker. J Diabetes Complications. 2012, 5: 1-5. CrossRef
Sinacore DR, Hastings MK, Bohnert KL, Fielder FA, Villareal DT, Blair VP, Johnson JE: Inflammatory Osteolysis in Diabetic Neuropathic (Charcot) Arthropathies of the Foot. Phys Therap. 2008, 88 (11): 1399-1407. 10.2522/ptj.20080025. CrossRef
Bramham R, Wraight P, May K: Management of Charcot neuroarthropathy. Diabet Foot J. 2011, 14 (4): 163-170.
Hastings MK, Sinacore DR, Fielder FA, Johnson JE: Bone Mineral Density During Total Contact Cast Immobilization for a Patient With Neuropathic (Charcot) Arthropathy. Phys Therap. 2005, 85 (3): 249-256.
Perrin BM, Gardner MJ, Suhaimi A, Murphy D: Charcot osteoarthropathy of the foot. Aust Fam Physician. 2010, 39 (3): 117-119. PubMed
Vella S, Cachia MJ: Charcot neuroarthropathy: pathogenesis diagnosis and medical management. Malta Med J. 2008, 20 (3): 13-19.
Pinzur MS, Lio T, Posner M: Treatment of Eichenholtz Stage I Charcot Foot Arthropathy with a Weight-bearing Total Contact Cast. Foot Ankle Int. 2006, 27 (5): 324-329. PubMed
Hunter A: The treatment of Charcot neuroarthropathy with an Aircast Pneumatic Walker: a case study. Podiatry Now. 2006, 9 (7): 44-47.
Anderson LB, DiPreta J: Charcot of the Calcaneous. Foot Ankle Clin. 2006, 11: 825-835. 10.1016/j.fcl.2006.06.010. CrossRef
Schlossbauer T, Mioc T, Sommerey S, Kessler SB, Reiser MF, Pfeifer KJ: Magnetic Resonance Imaging in Early Stage Charcot Arthropathy - correlation of imaging findings and clinical symptoms. Eur J Med Res. 2008, 13: 409-414. PubMed
Basu S, Chryssikos T, Houseni M, Malay DS, Shah J, Zhuang H, Alavi A: Potential role of FDG PET in the setting of diabetic neuro- osteoarthropathy: can it differentiate uncomplicated Charcot’s neuroarthropathy from osteomyelitis and soft-tissue infection?. Nucl Med Commun. 2007, 28: 465-472. 10.1097/MNM.0b013e328174447f. CrossRefPubMed
Johnsen B: Acute Charcot’s arthropathy: a difficult diagnosis. JAAPA. 2007, 20 (7): 22-26. PubMed
Ore HM, Watkinson D: Case study: Charcot’s neuropathy. Podiatry Now. 2007, 10 (7): 25-26.
Stuck RM, Sohn MW, Budiman E, Lee TA, Weiss KB: Charcot Arthropathy Risk Elevation in the Obese Diabetic Population. Am J Med. 2008, 121 (11): 1009-1014. CrossRef
Pappalardo J, Fitzgerald R: Utilization of Advanced Modalities in the Management of Diabetic Charcot Neuroarthropathy. Am J Med. 2010, 4 (5): 1114-1120.
Bernstein B, Motko J: Developing a Comprehensive Diagnostic and Treatment Plan for Charcot Neuroarthropathy - Pt. 1. Podiatry Management. 2008, 2: 151-161.
Rabinovich A: Conservative treatment can be efficacious in treatment of Charcot arthropathy. Orthopaedics Today. 2010, 11: 56-58.
Smith C, Kumar S, Causby R: The effectiveness of non-surgical interventions in the treatment of Charcot foot. Int J Evid Based Healthc. 2007, 5: 437-449. 10.1111/j.1479-6988.2007.00081.x. PubMed
Yaboln CM, Duggal N, Wu JS, Shetty SK, Dawson F, Hochman MG: A Review of Charcot Neuroarthropathy of the Midfoot and Hindfoot: every radiologist needs to know. Curr Probl Diagn Radiol. 2010, 39: 187-199. 10.1067/j.cpradiol.2009.06.001. CrossRef
Ramanujam CL, Facaros Z: An overview of conservative treatment options for diabetic Charcot foot neuroarthropathy. Diabet Foot Ankle. 2011, 2: 1-5.
CD-ROM: International Working Group on the Diabetic Foot: international consensus on the diabetic foot. 2011, Noordwijkerhout, Netherlands: International Diabetes Federation
- Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy: a systematic review
Tamara E Milne
Joseph R Rogers
Ewan M Kinnear
Helen V Martin
Peter A Lazzarini
Thomas R Quinton
Frances M Boyle
- BioMed Central