The Journal of Bone and Joint Surgery (American). 2008;90:754-759.
doi:10.2106/JBJS.F.01523
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Charcot Arthropathy and Immobilization in a Weight-Bearing Total Contact Cast

Leo J. de Souza, MBBS, FRCSEd, FRCS(C)1

1 Department of Orthopaedics-G2, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415. E-mail address: jill.lepper{at}co.hennepin.mn.us
Investigation performed at the Department of Orthopaedics, Hennepin County Medical Center, Minneapolis, Minnesota

Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

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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