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From Acute to Chronic

Monitoring the Progress of Charcot’s Arthropathy

Vanessa L. Nubé, DipPod^*, Margaret McGill, RN, MSc(Med), Lynda Molyneaux, RN and Dennis K. Yue, MD, FRACP, PhD

^* Senior Podiatrist, The Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia; third-year student, Department of Medicine, University of Sydney, Sydney, Australia.
Manager of Diabetes Services, The Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia.
Statistician, The Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia.
Director of Diabetes Services, The Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia; Professor, Department of Medicine, University of Sydney, Sydney, Australia. Mailing address: The Diabetes Centre, Level 10, Queen Mary Bldg, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia 2050.

Abstract

The monitoring of Charcot’s arthropathy in patients with diabetes mellitus is twofold: 1) assessment of disease activity as the condition progresses from the acute to the chronic phase, and 2) identification of structural abnormalities and complications that may arise as a result of the disease. The former guides the clinician as to the duration of primary treatment, and the latter provides important information regarding the long-term prognosis and facilitates clinical decision making regarding other treatments including surgery, footwear, and orthoses. The mainstay of assessing disease activity remains thorough and regular assessment of swelling, temperature differences, and bony abnormalities. Radiographic assessment performed at baseline and periodically throughout the course of the disease will show stages of early fracture and fragmentation followed by eventual trabecular bridging, ankylosis of the affected joints, and sclerosis, heralding the chronic phase of the disease. Radiographic assessment also provides visualization of bony deformities and prominences. In addition to these assessments, changes may be further quantified by the use of infrared dermal thermography and quantitative bone scanning techniques. Careful clinical monitoring of patients is essential to optimize treatment for acute Charcot’s arthropathy and improve the long-term outcome for patients presenting with this condition. (J Am Podiatr Med Assoc 92(7): 384-389, 2002)