Charcot Arthropathy and Immobilization in a Weight-Bearing Total Contact Cast

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Background:The standard management for Eichenholtz Stage-I Charcot arthropathy has been with non-weight-bearing total contact casts. The purpose of this study was to evaluate the results of the use of weight-bearing total contact casts for similar patients.Methods:Twenty-seven patients with Charcot arthropathy of the foot and ankle were studied prospectively over a period of eighteen years, from 1988 to 2006. The average duration of follow-up was 5.5 years. Of the twenty-seven patients, twenty-six had diabetes mellitus. Total contact casts were used to treat thirty-four feet with Eichenholtz Stage-I or early Stage-II Charcot arthropathy. These patients were allowed to bear weight as tolerated. Casts were changed at weekly intervals and were worn until resolution of the acute stage of the disease.Results:No deleterious effect from weight-bearing, specifically with regard to skin ulceration or rapid deterioration of the osseous architecture, was observed in thirty-three of the thirty-four feet.Conclusions:Immobilization in a weight-bearing total contact cast appears to be a safe method of treatment of acute Eichenholtz Stage-I Charcot arthropathy of the foot and ankle.Level of Evidence:Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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