American Diabetes Association
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Charcot Foot offloaded in stage 0 is associated with shorter total contact cast treatment and lower risk for recurrence and reconstructive surgery: a pilot study

posted on 2023-11-30, 17:13 authored by Johan Schoug, Per Katzman, Katarina Fagher, Magnus Löndahl


Charcot Foot (CF) requires prolonged offloading of the affected foot to decrease the risk of deformity. The earliest phase in active CF (stage 0) is characterized by inflammatory signs without established fractures or skeletal deformity. We investigated whether offloading in stage 0 influenced duration of total contact casting (TCC), risk of recurrence, and future need of surgery.

Research design and methods:

All patients treated for active CF at Skåne University Hospital, Sweden, between 2006-2019 were screened for participation in a retrospective cohort study. Included patients’ CF events were classified as stage 0 or 1, according to X-ray and MRI reports.


183 persons (61 (IQR 52-68) years, 37% type 1 DM, 62% men) were followed for 7.0 (3.9-11) years. In 198 analyzed CF events, 74 CF were offloaded in stage 0, and 124 in stage 1. Persons offloaded in stage 0 had significantly shorter TCC duration (75 (51-136) vs. 111.5 (72-158) days, p = 0.001). The difference sustained when only including MRI-confirmed CF. The risk of developing new ipsilateral CF events more than one year after introduced definitive footwear was lower in those offloaded in stage 0 (2.7 vs. 9.7%, p < 0.05). No person offloaded in stage 0 had reconstructive surgery, compared to 11 (8.9%) offloaded in stage 1 (p < 0.01). Amputation rates were similar.


Offloading CF in stage 0 was associated with shorter TCC treatment, lower risk of new CF event, and diminished need for reconstructive surgery. Future amputation risk was not affected.


This study was founded by unrestricted grants from Gyllenstiernska Krapperup Foundation and Sweden’s Southern Health Care Region.


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