Treatment of Charcot foot and ankle with a prefabricated removable walker brace and custom insole.

BACKGROUND: Removable walker braces have been used successfully to treat acute and chronic foot and ankle conditions including diabetic foot ulcers. We hypothesized that a removable walker brace may be successfully used in the management of the Charcot foot and ankle. METHODS: Twenty-five feet and ankles with Charcot arthropathy in 21 patients (bilateral in 4 patients) were treated with a prefabricated, pneumatic removable walker brace fitted with a custom orthotic insole. Follow-up data were collected from patient interview, examination, and radiography. RESULTS: Brace fitting was accomplished usually with a single visit to the prosthetist or pedorthist/orthotist. At the most recent evaluation, 17 (68%) feet and ankles had consolidation (stage III) of the Charcot arthropathy (average duration of brace use, 29+/-19 weeks) and were subsequently treated with rocker sole shoes, insoles, and ankle foot orthoses; 8 (32%) feet and ankles had ongoing brace treatment. Three feet developed new deformity during brace treatment, but average radiographic parameters of hindfoot to forefoot alignment had minimal change between initial and final radiographs at an average of 36+/-24 weeks after initial radiographic evaluation. CONCLUSIONS: The prefabricated, pneumatic removable walker brace fitted with a custom insole was successful in the management of the Charcot foot and ankle and had a high satisfaction rate and safety profile despite frequent, albeit usually minor, complications.

Health related quality of life in patients with Charcot arthropathy of the foot and ankle.

BACKGROUND: Clinical observation suggests that Charcot arthropathy of the foot and ankle has major negative consequences on the quality of life of neuropathic patients, particularly those with diabetes. We hypothesized that the quality of life in patients with Charcot arthropathy may be aggravated by Aboriginal ethnicity and rural residence because of limited access to timely specialty healthcare. METHODS: Sixty patients with Charcot arthropathy were interviewed with the Short Form 36 (SF-36) Health Survey. RESULTS: Mean Physical Component Summary (PCS) score was 31+/-8 points and mean Mental Component Summary (MCS) score was 45+/-10 points. Mean PCS and MCS scores were not affected by gender, ethnicity, residence, or Charcot stage. Mean PCS score was significantly lower in non-employed (unemployed or retired) than employed patients and in patients who did not use alcohol than those who used alcohol; MCS score was not affected by employment status or alcohol use. CONCLUSIONS: Charcot arthropathy has a major negative effect on quality of life. The SF-36 survey was sensitive to the physical effects, but not to mental effects, of Charcot arthropathy.