Charcot foot is a rare but devastating complication of diabetes. We aimed to get a clear picture of the actual circumstances in which Charcot foot occurs and how it is managed. Emphasis was placed on epidemiological data (age at occurrence, diabetes duration, side of Charcot foot,…) and data about management (time to diagnosis, deformation present at diagnosis, method of immobilization).
Thirty-four multidisciplinary diabetic foot clinics in Belgium prospectively registered 62 cases with acute Charcot foot in 2014 and followed them for up to six months in terms of treatment and outcome. Data were collected for the purpose of quality-of-care monitoring. The data set was split in 2 different ways, after which analysis was performed. In a first phase, the data set was split in a subgroup ‘acute Charcot foot with wound at presentation (N=27)’ and a subgroup ‘acute Charcot foot without wound at presentation (N=35)’. In a second phase, the data set was split in a subgroup ‘acute Charcot foot with deformation at presentation (N= 40)’ and a subgroup ‘acute Charcot foot without deformation at presentation (N=22)’
The prevalence of deformation at first visit was significantly higher in case a wound was already present (85,2% vs. 48,6%, P<0,05). The occurrence of new wounds located at the fulcrum of the deformity causing a pressure point during follow-up was significantly higher in the group of patients with wounds at the first visit (55,6% vs. 11,4%, P<0,05). This was also the case for the occurrence of new wounds outside the pressure point (25,9% vs. 0%, P<0,05). Considering treatment, the use of immobilization of the foot was significantly higher in the group of patients without wounds at the first visit (100% vs. 85,2%, P<0,05). Considering the split in groups with or without deformation at first visit, the only significant difference between the two groups, was the higher prevalence of wounds at the first visit in the group with deformation (57,5% vs. 18,2%, P<0,05).
The presence of wounds and deformation proved to be significantly and positively associated at time of the first visit. Furthermore, new wounds preferentially occurred at the fulcrum of the deformity of the Charcot foot by causing a pressure point. The weakness of this study is the low number of patients that is probably responsible for the lack of other significant differences between the groups.