TY - JOUR
T1 - Immobilization-induced osteolysis and recovery in neuropathic foot impairments
AU - Sinacore, David R.
AU - Hastings, Mary K.
AU - Bohnert, Kathryn L.
AU - Strube, Michael J.
AU - Gutekunst, David J.
AU - Johnson, Jeffrey E.
PY - 2017/12
Y1 - 2017/12
N2 - Background Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery. Objective To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33–53 weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA). Methods Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry. Results Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p < 0.01); BMD in NPU immobilized feet averaged 486 ± 136 mg/cm2, and CNA immobilized feet averaged 456 ± 138 mg/cm2, p > 0.05). After immobilization, index NPU feet lost 27 mg/cm2; CNA feet lost 47 mg/cm2 of BMD, p < 0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic. Conclusions There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.
AB - Background Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery. Objective To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33–53 weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA). Methods Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry. Results Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p < 0.01); BMD in NPU immobilized feet averaged 486 ± 136 mg/cm2, and CNA immobilized feet averaged 456 ± 138 mg/cm2, p > 0.05). After immobilization, index NPU feet lost 27 mg/cm2; CNA feet lost 47 mg/cm2 of BMD, p < 0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic. Conclusions There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.
KW - Bone loss
KW - Neuropathic (Charcot) osteoarthropathy
KW - Neuropathic plantar ulcers
KW - Quantitative ultrasonometry
KW - Total contact casting
UR - http://www.scopus.com/inward/record.url?scp=85029698456&partnerID=8YFLogxK
U2 - 10.1016/j.bone.2017.09.009
DO - 10.1016/j.bone.2017.09.009
M3 - Article
C2 - 28942120
AN - SCOPUS:85029698456
VL - 105
SP - 237
EP - 244
JO - Bone
JF - Bone
SN - 8756-3282
ER -