15th December 2017, Volume 130 Number 1467

Joanne Dixon, Joshua Coulter, Michele Garrett, Rick Cutfield

Charcot neuropathic osteoarthropathy (CN) is a degenerative arthropathy affecting single or multiple joints resulting from significant peripheral neuropathy. This leads to fractures or dislocations of the bones and joints of…

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Summary

Charcot neuropathic osteoarthropathy occurs in people with diabetes and diabetes-related nerve damage of the feet. It presents as a red, hot and swollen foot and requires immediate medical attention and treatment. It can often take several weeks before the right diagnosis is made, leading to delays in treatment and long-term damage to the foot. People with longstanding diabetes and nerve damage in the feet should be aware of this condition and seek medical attention quickly if they notice these symptoms.

Abstract

Aim

To review the characteristics, management and outcomes one year after diagnosis in patients with diabetes related charcot neuropathic osteoarthropathy (CN) treated at the Diabetes Podiatry service, Waitemata District Health Board (WDHB) between 2000–2014.

Method

Patients with diabetes and recorded diagnosis of CN were identified from the podiatry service records. Clinical details were retrospectively obtained from WDHB databases and patient medical records.

Results

Forty-one patients were included, 31 had type 2 diabetes, 10 had type 1 diabetes. At presentation, the median duration of all-type diabetes was 15 years. The median time from symptom onset to diagnosis was 17 weeks. Symptoms at presentation were: oedema (49%), warmth (73%), erythema (17%), swelling (90%) and pain (60%). Concomitant ulcers were present in 32%, deformities 83%, osteomyelitis 2% and septic arthritis 2%. Mean time to ambulation in modified shoes was 21.3 weeks (±11.5). Complication rates one year from diagnosis for ulcers, osteomyelitis, amputations and all-cause mortality were 34%, 2%, 2% and 5% respectively.

Conclusion

Time to diagnosis of CN was shorter than previously reported, though the high rate of deformities still suggests a significant delay in diagnosis. Increased education of healthcare professionals and people with diabetes-related neuropathy is important to ensure early diagnosis and appropriate management to reduce deformities and complications.

Author Information

Joanne Dixon, Endocrinology Registrar, Endocrinology and Diabetes Department, Waitemata District Health Board, Auckland; Joshua Coulter, Medical Student, Auckland Medical School, Auckland;
Michele Garrett, Podiatrist, Endocrinology and Diabetes Department, Waitemata District Health Board, Auckland; Rick Cutfield, Endocrinologist, Endocrinology and Diabetes Department, Waitemata District Health Board, Auckland.

Correspondence

Joanne Dixon, Endocrinology and Diabetes Department, Waitemata District Health Board Postal address: 1/16 Corunna Road, Milford, Auckland.

Correspondence Email

joanne_thong@hotmail.com

Competing Interests

Nil.

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