DMRR special issue: The Charcot foot
The Charcot foot remains an intriguing topic. Despite having a rather small incidence rate in comparison to foot ulcers or amputation, it is a topic that receives a fair bit of attention in research.
That is probably explained by the challenging (and interesting) medical questions on the one hand, and the devastating consequences for patients on the other hand. Three articles in the special issue deal with the various aspects of diagnosis and treatment of Charcot neuroarthropathy.
Dr. Petrova and Prof. Edmonds provide the overview, from the multifactorial pathogenesis (with neuropathy and increased mechanical forces, bone resorption and fractures, trauma, and inﬂammation as most important factors), via presentation and diagnosis, to the various treatment options. Casting therapy remains the mainstay therapy, while pharmacological treatments are still under debate. The authors further write that a better understanding of the cellular mechanisms of the pathological bone is needed.
The final treatment option described is surgery, an option with which Dr. Pinzur and Dr. Wukich specifically deal in their articles. Surgical treatment is not without risk, but a non-braceable deformity associated with instability will be at higher risk when left untreated. For details on surgical techniques as described by the various authors, one should read the full well-written papers. One message to take home as well is the importance of not only performing the surgical operation, but the entire multidisciplinary team in preparing a patient for the operation as well as ensuring high quality care afterwards.
http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2734/abstract http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2750/abstract http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2748/abstract