Personalised Orthoses as a Good Treatment Option for Charcot Neuro-osteoarthropathy of the Foot
This study was designed to assess the biomechanical features of feet with and without Charcot neuro-osteoarthropathy (CN) and then, based on the individual characteristics of each foot, to prescribe a personalised orthopodologic therapeutic option targeted at achieving the structural stability of the foot and, thus, prevent ulcers.
A descriptive longitudinal study with 1 year of follow-up was conducted of patients with CN associated with several aetiologies.
Before this study, ulcers in these patients had been treated by conservative surgery or using felt, bandaging, and cast walker boots.
However, they had never received orthotic treatment to prevent re-ulcerations.
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All of the patients’ feet were subjected to a biomechanical study; dorsiflexion of the ankle was measured with the knee flexed and the heel in contact with the ground using a goniometer aligned with the floor (stable arm).
Dorsiflexion of the first digit was also measured using a goniometer, with the stable arm in the medial metatarsal region and the mobile arm in the medial region of the first digit.
The authors determined the calcaneal stance position by measuring the position of the calcaneal bisection at right angles to the calcaneal stance plane and the Foot Posture Index.
A radiophotopodogram was prepared by superimposing an imprint of the sole on a plantar radiograph.
Based on the results of these tests, an orthopedic insole was prepared and therapeutic footwear prescribed for each foot.
The findings of this study indicated that 1 year of personalised orthotic treatment was able to reduce the ulceration rate to 9.8% after a year in feet with CN and to 0% in feet without CN.
This suggests that conservative management involving personalised orthotic treatment based on off-loading insoles and therapeutic footwear according to the foot deformity is the best initial option in patients with CN, without forgetting to also consider the contralateral unaffected foot.
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References:
- Fernández, M. L. G., Lozano, R. M., Rincón, C. M., Hernández, D. M. (2014) Personalised Orthoses as a Good Treatment Option for Charcot Neuro-osteoarthropathy of the Foot. Journal of the American Podiatric Medical Association: July/August 2014, Vol. 104, No. 4, pp. 375-382
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