Acute Charcot Arthropathy in Patients with Diabetes Mellitus: Healing Times by Foot Location David R. Sinacore ABSTRACT Foot deformity and lower extremity dysfunction are determined. The results indicate all (100%) of the acute (Charcot) fractures, subluxations, or debilitating complications of diabetes mellitus which often lead to significant permanent dislocations healed in an average of 86  45 days. Actue Charcot arthropathies of the ankle, hindfoot, disability. Acute diabetic neuroarthropathy (Charcot arthropathy) directly leads to foot or midfoot take longer to heal by TCC than arthropathies localized to the forefoot. Adherence deformity, subsequent lower-extremity complications and may lead to lower-extremity to partial weight bearing with assistive devices during casting and early institution of cast amputation, if not identified and managed appropriately. The purpose of this study is to report immobilization are critical factors associated with shorter healing times using TCC. Physicians, the healing times of acute-onset neuropathic arthropathies (fractures, joint subluxations or rehabilitation specialists and third-party payers should be aware of the length of time required to dislocations) in individuals with diabetes mellitus by foot location using the ambulatory heal acute Charcot foot arthropathies at all locations of the foot using TCC. ( Journal of Diabetes and method of total-contact casting (TCC). In addition, the identification of critical subject characteristic Its Complications 12; 5: 287–293, 1998.)  1998 Elsevier Science Inc. which influence healing outcomes were INTRODUCTION foot. Any delay in the early recognition and initiation of treatment can negatively affect healing times as well D iabetic neuroarthropathy (Charcot arthropa- as the ultimate therapeutic outcomes, thereby further thy) of the foot resulting from acute frac- contributing to deformity and long-term disability. 1 tures, subluxations, or dislocations can cause The prevalence of Charcot arthropathy in individuals permanent disfiguring foot deformity and with diabetes mellitus (DM) is difficult to estimate with can be a very difficult complication to manage because any certainty due to limited reporting and surveillance of the increased risk for skin breakdown and lower- of outpatient data. Depending on the prevalence of dia- extremity amputation. The immediate cause of Charcot betes mellitus in high-risk populations, estimates of Char- arthropathy remains poorly understood, and many cli- cot arthropathy vary between 0.1% and 28%. 2–6 More than nicians fail to recognize the initial involvement in the likely, these may be underestimates, because the out- patient setting (i.e., the most common setting for indi- viduals with diabetes and acute foot dysfunction to Program in Physical Therapy, Washington University School of seek care) is notoriously under-reported. In addition, Medicine and Consultant, Diabetic Foot Center, Barnes-Jewish Hos- pital, BJC Health System Inc, St. Louis, Missouri, USA these estimates do not reflect the enormous morbidity, Reprint requests to be sent to: DR. D. R. Sinacore at Program in disability, and economic costs associated with these most Physical Therapy, Campus Box 8502, Washington University School of Medicine, St Louis, MO 63110. troublesome complications. 7,8 Even hospital-based esti- Journal of Diabetes and Its Complications 1998; 12:287–293  1998 Elsevier Science Inc. All rights reserved. 1056-8727/98/$19.00 655 Avenue of the Americas, New York, NY 10010 PII S1056-8727(98)00006-3