Identification Of High-risk Groups Of Charcot Foot In The People With Diabetic Foot Neuropathic Ulcerations

Background:Diabetic foot ulcerations have been extensively reported as a serious com-plication of diabetes mellitus associated with a high degree of morbidity and mortality. Diabetic peripheral neuropathy can cause neuropathic foot ulcers (NU), some people can be further development to Charcot Neuro-osteoarthropathy (CN).CN is relatively rare but important and devastating disorder described as the progressive destruction of bone and joints in a patient with peripheral neuropathy. The patients suffering CN will lost their capacity to work and have to endure the recurrent ulcers, some face amputations to pre-serve life. It is important to identify the high-risk groups of CN in the people with diabetic foot neuropathic ulcerations.Objective:To identify high-risk groups of CN in the people with diabetic foot neuropathic ulcerations through summarizing and comparing the clini-cal characteristics between the two groups. Methods:Part Ⅰ:A retrospective analysis of the clinical characteristics and prognosis of 20 hospitalized patients with CN in the Air force general hospital from June 2008 to June 2013. Part Ⅱ:A retrospective cohort of 20 patients with CN compared with 58 patients with NU who were followed up until June 2014 without foot deformity in the Air force general hospital. To compare all of the pa-tient’s general condition, diabetes duration, distribution of foot ulcers, examination and laboratory results, diabetic chronic complications and plain radiographic features. Results: Part Ⅰ:1) All the 20 cases of diabetes CN were single foot lesions,75 percent males, the mean duration of diabetes was (12±6) years, the age at the time of diagnosed CN was (55±8)years. The feet numbness had been about six years before the foot deformity. The affected population typically has well preserved arterial blood flow in the foot, poor gly-cemic control, most of them were overweight, and blood lipid normal range. Diabetic autonomic neuropathy and nephropathy were the most common long-term complications of diabetes CN.90 percent of CN had repeated diabetic foot ulcers and 73.69 percent of the wounds distributed in metatarsophalangeal joint and arches of the plantar.2) 4 cases accepted amputations,7cases underwent toes amputations,6 cases were healed after deb-ridement and wound dressing. 1 case underwent the facet screw fixation of the foot,1 case was configurated correction shoes, lease was discharged and lost to follow-up. Follow up (1-5) years, lease died from heart attack,2cases were on long-term hemodialysis, lease had recurrent ulcers. Others were well. Part II:1) Diabetics CN and NU often occurred in male between the ages of 50 and 60.There were not significant difference in the pro-portion of smokers, the value of BMI,HbAlc,bloodlipid, the diameters of the dorsalis pedis artery and the prevalence of diabetic nephropathy(stageⅢ-Ⅳ), proliferation dia-betic retinopathy, coronary heart disease. (P>0.05) between the two groups. All the foot wound were around with callosity.2) The majority of CN group had shorter duration of diabetes but longer duration of feet numbness than that of NU. The feet of CN group were the higher incidence of recurrent ulcers but without ischemia. The more patients were with diabetic autonomic neuropathy but lower prevalence of hypertension. Most of Char-cot foot wounds were distributed around the arches of the plantar while a majority of the wounds of NU group were under metatarsophalangeal joint; Plain radiography showed the characteristic of CN was Osteoporosis, joint damage, dislocation or subluxation while that of NU was local bone osteolytic destruction. It was more common that arteriae dorsa-lis pedis calcification shadow showed in the Plain radiography of the NU group. ALL the difference between the 2 groups was statistically significant (P<0.05).Conclusions The characteristics of high-risk groups of diabetics Charcot foot in the people with diabetic foot neuropathic ulcerations are middle aged, male, severe periph-eral and autonomic neuropathy and the feet always with recurrent ulcers but without ischemic lesions. Offloading the foot and immobilization based on individual merit are essential and are the most important recommendations in the active acute stage of the Charcot foot.