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Background <p>Charcot neuroarthropathy (CN), predominantly associated with diabetes mellitus, is a progressive condition that affects the bones and joints of the foot and ankle. Despite its high prevalence in the Indian population, data on conservative management outcomes of CN tailored to the context remain sparse.</p> Materials and methods <p>This retrospective longitudinal case series analyzed outcomes of 42 patients with CN treated conservatively at a South Indian tertiary care center from 2019 to 2024. The study included adults with CN treated non-surgically and excluded those with incomplete records or lost to follow-up. Patients with unstable deformities or severe infections requiring urgent surgical intervention were also excluded. Primary outcome was limb salvage. Secondary outcomes included duration of total contact casting (TCC), radiological measurements (Meary’s angle, calcaneal pitch and cuboid height), long-term bracing, ulcer recurrence, recurrence of CN and contralateral CN.</p> Results <p>Forty-two patients (mean age 57.5 ± 8.2&#xa0;years) were included; 57.1% had left foot involvement and the mean HbA1c was 8.6 ± 1.6%. The total TCC duration was 3.9 ± 1.2&#xa0;months. Subsequent Charcot Restraint Orthotic Walker (CROW) use averaged 6.6 ± 3.8&#xa0;months, with long-term bracing required in 7.1%. Recurrence of CN occurred in 2.4%, contralateral CN in 14.3%, and ulcer recurrence in 9.5%. Limb salvage was achieved in all patients. Radiographic measures showed no significant deformity progression post-intervention. Recurrence-free survival was 92.9% at 1&#xa0;year, 86.5% at 3&#xa0;years, and 65.5% at 5&#xa0;years; however, the number of patients at risk decreased substantially at later follow-up intervals, and therefore the 5-year survival estimate should be interpreted as exploratory.</p> Conclusion <p>The conservative management using TCC, adapted for local climatic conditions, followed by structured orthotic support was associated with favorable rates of limb salvage and complication rates. However, the observed 100% limb salvage rate and lower complications may be inflated due to cohort selection criteria which excluded unstable deformities and severe infections.</p>

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Mid-term outcomes of a tropical climate-adapted modified total contact cast for diabetic Charcot neuroarthropathy

  • 期刊论文

  • 发表日期：

    2026年5月18日

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  • Ani Susan Abraham,
  • Dennis P. Jose,
  • Pratik Vishavadia,
  • Rajesh Simon

摘要

Background

Charcot neuroarthropathy (CN), predominantly associated with diabetes mellitus, is a progressive condition that affects the bones and joints of the foot and ankle. Despite its high prevalence in the Indian population, data on conservative management outcomes of CN tailored to the context remain sparse.

Materials and methods

This retrospective longitudinal case series analyzed outcomes of 42 patients with CN treated conservatively at a South Indian tertiary care center from 2019 to 2024. The study included adults with CN treated non-surgically and excluded those with incomplete records or lost to follow-up. Patients with unstable deformities or severe infections requiring urgent surgical intervention were also excluded. Primary outcome was limb salvage. Secondary outcomes included duration of total contact casting (TCC), radiological measurements (Meary’s angle, calcaneal pitch and cuboid height), long-term bracing, ulcer recurrence, recurrence of CN and contralateral CN.

Results

Forty-two patients (mean age 57.5 ± 8.2 years) were included; 57.1% had left foot involvement and the mean HbA1c was 8.6 ± 1.6%. The total TCC duration was 3.9 ± 1.2 months. Subsequent Charcot Restraint Orthotic Walker (CROW) use averaged 6.6 ± 3.8 months, with long-term bracing required in 7.1%. Recurrence of CN occurred in 2.4%, contralateral CN in 14.3%, and ulcer recurrence in 9.5%. Limb salvage was achieved in all patients. Radiographic measures showed no significant deformity progression post-intervention. Recurrence-free survival was 92.9% at 1 year, 86.5% at 3 years, and 65.5% at 5 years; however, the number of patients at risk decreased substantially at later follow-up intervals, and therefore the 5-year survival estimate should be interpreted as exploratory.

Conclusion

The conservative management using TCC, adapted for local climatic conditions, followed by structured orthotic support was associated with favorable rates of limb salvage and complication rates. However, the observed 100% limb salvage rate and lower complications may be inflated due to cohort selection criteria which excluded unstable deformities and severe infections.