M. Aruna, Padala Ravi Kumar, Deepak Kumar Dash, Debasish Patro, T. Radha krishna, Manas Ranjan Kundu, Sudhi Ranjan Pattanaik
Keywords
Diabetes mellitus • Acute Charcot neuroarthropathy • Chronic Charcot neuroarthropathy • Clinical resolution
Abstract
Objective The aim of this study was to assess demographic, clinical, biochemical, radiological profile and treatment response in diabetic patients with Charcot neuroarthropathy (CN).
Methods This was a prospective study for screening of CN in patients with diabetes mellitus (DM) attending tertiary care centre over a period of 1 year. Acute CN (ACN) was diagnosed based on clinical features of local inflammation and temperature difference of > 2 °C from the normal foot after exclusion of other inflammatory causes. Chronic CN (CCN) was diagnosed when no inflammatory signs were present in a deformed foot with radiological findings supportive of diagnosis. In all these patients, demographic data, clinical features, biochemical investigations, X-ray, and MRI foot were done. The effect of offloading and customized foot wear in ACN, CCN were, respectively, studied over 1 year.
Results Out of 5049 DM patients screened for CN over 1 year, 25 patients (0.49%) were diagnosed to have CN, of which 12 had ACN (0.23%) and 13 had CCN (0.26%). CN patients had significantly higher mean body mass index (BMI) (27.9 vs. 26.2 kg/m 2 ; p = 0.02), longer duration of DM (12 vs. 9.6 years; p < 0.001), higher HbA1c (10.3 vs. 8.8%; p = 0.001), greater degree of peripheral neuropathy and retinopathy compared to controls. MRI could be able to detect 25% ACN cases where X-rays were non-diagnostic. The median duration of clinical resolution was 3 months in ACN patients.
Conclusions High index of suspicion is required for diagnosing CN in DM patients.
