Long-term outcome and quality of life in patients with Charcot foot

Abstract

Background

There is only sparse scientific data about the long-term effects of the Charcot foot on patients’ lives and the clinical outcome. This study evaluates the long-term effects of diabetic Charcot foot.

Methods

A cross-sectional follow-up study of consecutive series of patients with Charcot foot referred to the University Hospital Diabetic Foot and Ankle Clinic between 1991 and 2002.

Results

Forty-one patients were referred with Charcot foot between 1991 and 2002. After an average follow-up of 8 years their overall mortality rate was 29% (12/41) and 29 patients (30 Charcot feet) have been followed more than 5 years. Sixty-seven percent of Charcot feet suffered at least one episode of ulceration and 50% (15/30) of affected feet had surgical treatment resulting in 29 operations. Simple exostectomy was successful in 62% of cases. The need for surgical management increased markedly 4 years after the diagnosis. Correct diagnosis within 3 months resulted in better functional outcome (AOFAS) and walking distance (p = 0.006 and p = 0.008, respectively). Lower SF-36 component scores in physical functioning, social functioning and general health perceptions were found when the study population was compared to the general population and chronically ill control subjects.

Conclusions

Diabetic Charcot foot decreases patient's physical functioning and general health but does not usually affect mental health. Surgical management is often required with an increase 4 years post-diagnosis. A delay of diagnosis of more than 3 months was found to adversely affect the quality of life and functional outcome.

Introduction

The prevalence of diabetes mellitus and associated end-stage complications is increasing exponentially world-wide [1]. Charcot foot is one of the most disabling complications encountered by patients with diabetes. The incidence of Charcot foot is estimated to be about 8.5 per 1000 patients with diabetes per year [2]. It is a common risk factor for ulcers and amputation and 40–60% of all lower extremity amputations are performed on patients with diabetes [3], [4]. The risk of foot ulceration and amputation increases exponentially if the mid-foot collapses and bony plantar prominences develop before cessation of the acute Charcot process [5]. As acute Charcot arthropathy progresses it severely impairs the quality of life but little is known about the morbidity of the disease process in affected individuals with long standing Charcot foot [6]. Several authors have recently recommended early realignment surgery for the most deformed or unstable Charcot cases to prevent subsequent ulcerations and attempt to improve patients’ long-term outcome and quality of life [6], [7]. Our study presents a cross-sectional long-term follow-up of a cohort of patients with Charcot foot managed initially non-operatively.