Diagnosis and treatment of Charcot foot in patients with diabetes mellitus

Serhii Myhailovych Vasyliuk; Ivan Romanovych Labiak; Oksana Myhailivna Makarchuk; Oleg Stepanovych Tkachuk; Nataliia Myhailivna Pavliuk; Oryna Zinoviivna Decyk; Michael Ivanovich Sheremet; Yan Viktorovich Gyrla; Oleksandr Vyacheslavovich Bilookyi; Andriy Valentinovich Tiuev; Andriy Pavlovich Skorina

Serhii Myhailovych Vasyliuk Department of Surgery No.1 and Pediatric Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
Ivan Romanovych Labiak Department of Surgery No.1 and Pediatric Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
Oksana Myhailivna Makarchuk Department of Obstetrics and Gynecology of Postgraduate Education, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
Oleg Stepanovych Tkachuk Department of Surgery No.1 and Pediatric Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
Nataliia Myhailivna Pavliuk Department of Surgery No.1 and Pediatric Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
Oryna Zinoviivna Decyk Department of Social Medicine and Public Health, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
Michael Ivanovich Sheremet Department of Surgery No.1, Bukovinian State Medical University, Chernivtsi, Ukraine
Yan Viktorovich Gyrla Department of Surgery No.1, Bukovinian State Medical University, Chernivtsi, Ukraine
Oleksandr Vyacheslavovich Bilookyi Department of Surgery No.1, Bukovinian State Medical University, Chernivtsi, Ukraine
Andriy Valentinovich Tiuev Department of Surgery, Municipal Non-Profit Enterprise Chernivtsi Regional Hospital, Chernivtsi, Ukraine
Andriy Pavlovich Skorina Department of Surgery, Municipal Non-Profit Enterprise Chernivtsi Regional Hospital, Chernivtsi, Ukraine

Keywords: Charcot foot, diabetes, MRI, total contact cast, orthosis

Abstract

In recent years, we have seen a significant increase in the number of works devoted to the Charcot foot. The aim was to propose and evaluate the optimal approach to diagnosing and treating Charcot foot in patients with type 2 diabetes. We treated 115 patients with type 2 diabetes and Charcot foot. Patients were separated into two groups: the TCC group (65), where it was administrated the treatment with a total contact cast (TCC) and the ORTHOSIS group, where immobilization with rigid orthoses was carried out. The TCC group showed worse results (p=0.004). In the TCC group, the frequency of recurrence of Charcot arthropathy in the next 2 months after the end of treatment was significantly higher (p=0.04). The frequency of development of Charcot arthropathy on the contralateral limb during treatment or in the coming months after it did not differ significantly between patient groups (p=0.14). X-ray in patients with Charcot foot is ineffective in establishing a clinical diagnosis and choosing treatment tactics. MRI of the foot with or without intravenous contrast should be chosen. Staged conservative treatment of Charcot foot shows a positive effect in 80.9% of observations.