TY - JOUR
T1 - Diagnosis and treatment of active charcot neuro-osteoarthropathy in persons with diabetes mellitus
T2 - A systematic review
AU - Raspovic, Katherine M.
AU - Schaper, Nicolaas C.
AU - Gooday, Catherine
AU - Bal, Arun
AU - Bem, Robert
AU - Chhabra, Avneesh
AU - Hastings, Mary
AU - Holmes, Crystal
AU - Petrova, Nina L.
AU - Santini Araujo, Maria Gala
AU - Senneville, Eric
AU - Wukich, Dane K.
N1 - Funding Information:
The authors wish to acknowledge Helen Mayo, Faculty Associate and University Librarian at University of Texas Southwestern Medical Center (Dallas, Texas, United States of America) who designed the search strings and performed the literature search for this review. We would also like to acknowledge the kind expert peer review of this manuscript by Robert Frykberg and the review of Jaap Van Netten and the IWGDF Editorial Board. We also kindly acknowledge the expert review of the clinical questions by the IWGDF Editorial Board and the following international experts: Rasmus Bo Jansen, Denmark; Patrick Burns, United States of America; Robert Frykberg, United States of America; Venu Kavarthapu, United Kingdom; Armin Koller, Germany; George T. Liu, United States of America (also on behalf of the American College of Foot and Ankle Surgeons); Nicholas Lowery, United States of America; Fermin Martinez, Mexico; Andrew Meyr, United States of America; Luca Dalla Paola, Italy; Dario Pitocco, Italy; Lee Rogers, United States of America (also on behalf of the American Podiatric Medical Association), Juan Manuel Rios Ruh, Spain; Luigi Uccioli, Italy; Vijay Viswanathan, India (also on behalf of D‐Foot International). Production of the 2023 IWGDF Guidelines was supported by unrestricted grants from Advanced Oxygen Therapy Inc., Essity, Mölnlycke, Reapplix, and Urgo Medical. These sponsors did not have any communication related to the systematic reviews of the literature or related to the guidelines with working group members during the writing of the guidelines and have not seen any guideline or guideline‐related document before publication.
Publisher Copyright:
© 2023 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.
PY - 2023
Y1 - 2023
N2 - Background: There are uncertainties regarding the diagnostic criteria, optimal treatment methods, interventions, monitoring and determination of remission of Charcot neuro-osteoarthropathy (CNO) of the foot and ankle in people with diabetes mellitus (DM). The aims of this systematic review are to investigate the evidence for the diagnosis and subsequent treatment, to clarify the objective methods for determining remission and to evaluate the evidence for the prevention of re-activation in people with CNO, DM and intact skin. Methods: We performed a systematic review based on clinical questions in the following categories: Diagnosis, Treatment, Identification of Remission and Prevention of Re-Activation in people with CNO, DM and intact skin. Included controlled studies were assessed for methodological quality and key data from all studies were extracted. Results: We identified 37 studies for inclusion in this systematic review. Fourteen retrospective and observational studies relevant to the diagnosis of active CNO with respect to clinical examination, imaging and blood laboratory tests in patients with DM and intact skin were included. We identified 18 studies relevant to the treatment of active CNO. These studies included those focused on offloading (total contact cast, removable/non-removable knee high devices), medical treatment and surgical treatment in the setting of active CNO. Five observational studies were identified regarding the identification of remission in patients who had been treated for active CNO. We did not identify any studies that met our inclusion criteria for the prevention of re-activation in patients with DM and intact skin who had been previously treated for active CNO and were in remission. Conclusions: There is a paucity of high-quality data on the diagnosis, treatment, and prognosis of active CNO in people with DM and intact skin. Further research is warranted to address the issues surrounding this complex disease.
AB - Background: There are uncertainties regarding the diagnostic criteria, optimal treatment methods, interventions, monitoring and determination of remission of Charcot neuro-osteoarthropathy (CNO) of the foot and ankle in people with diabetes mellitus (DM). The aims of this systematic review are to investigate the evidence for the diagnosis and subsequent treatment, to clarify the objective methods for determining remission and to evaluate the evidence for the prevention of re-activation in people with CNO, DM and intact skin. Methods: We performed a systematic review based on clinical questions in the following categories: Diagnosis, Treatment, Identification of Remission and Prevention of Re-Activation in people with CNO, DM and intact skin. Included controlled studies were assessed for methodological quality and key data from all studies were extracted. Results: We identified 37 studies for inclusion in this systematic review. Fourteen retrospective and observational studies relevant to the diagnosis of active CNO with respect to clinical examination, imaging and blood laboratory tests in patients with DM and intact skin were included. We identified 18 studies relevant to the treatment of active CNO. These studies included those focused on offloading (total contact cast, removable/non-removable knee high devices), medical treatment and surgical treatment in the setting of active CNO. Five observational studies were identified regarding the identification of remission in patients who had been treated for active CNO. We did not identify any studies that met our inclusion criteria for the prevention of re-activation in patients with DM and intact skin who had been previously treated for active CNO and were in remission. Conclusions: There is a paucity of high-quality data on the diagnosis, treatment, and prognosis of active CNO in people with DM and intact skin. Further research is warranted to address the issues surrounding this complex disease.
KW - charcot foot
KW - charcot neuro-osteoarthropathy
KW - charcot neuroarthropathy
KW - charcot osteoarthropathy
KW - diabetic foot
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85159211427&partnerID=8YFLogxK
U2 - 10.1002/dmrr.3653
DO - 10.1002/dmrr.3653
M3 - Article
C2 - 37179484
AN - SCOPUS:85159211427
SN - 1520-7552
JO - Diabetes/Metabolism Research and Reviews
JF - Diabetes/Metabolism Research and Reviews
ER -