Start treatment early to avoid Charcot foot deformityBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2765 (Published 01 May 2012) Cite this as: BMJ 2012;344:e2765
- Ernst A Chantelau, physician1
Baglioni and colleagues did not cover outcome in their article on acute Charcot foot.1 They discussed stage I disease—that is, positive results on radiography and magnetic resonance imaging2—but Charcot foot deformity may be avoided if offloading and immobilisation are started during stage 0.3
Stage 0 is characterised by painless swelling from common skeletal trauma (ankle sprain, stress injury),4 and bone damage is confined to subcortical trabecular microfractures (demonstrated on magnetic resonance imaging rather than radiography).2 Offloading is required for about three months. If stage 0 remains untreated, continued walking causes progression to stage I (cortical fractures and deformity); stage I may need to be treated for up to 12 months, depending on the extent of the skeletal destruction.5
Cite this as: BMJ 2012;344:e2765
Competing interests: None declared.