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Charcot Foot and Ankle Diagnosis: Benefits of a Multidisciplinary Approach
Timely diagnosis and appropriate treatment are essential for patients with Charcot Foot and Ankle, a condition affecting the bones, joints, and soft tissues in the feet of people with peripheral neuropathy. An accurate diagnosis is even more important in patients with diabetes.
The diagnosis and management of Charcot Foot and Ankle require a multidisciplinary healthcare team, where the diabetic foot specialist and the diabetologist play coordinating roles.
In the following sections, we will examine the benefits of a multidisciplinary approach to the diagnosis of Charcot Foot and Ankle, along with the important role of patients.
Advantages of a multidisciplinary healthcare team
Charcot Foot and Ankle typically develops over time and requires a number of factors to occur. Peripheral neuropathy is always present. The reduced sensation caused by peripheral neuropathy makes small injuries or traumas unnoticed, and their accumulation weakens the bones, which progressively deform.
Patients with diabetes have a 0.3 to 7.5% risk of developing Charcot Foot and Ankle, mainly due to nerve damage caused by uncontrolled blood sugar levels. In 2019, there were an estimated 463 million people living with diabetes worldwide. The number is expected to rise a staggering 700 million by 2045 according to the International Diabetes Federation (IDF). Furthermore, diabetic foot and lower extremity complications are an important source of morbidity, affecting 40 to 60 million of those living with diabetes, and lower extremity amputation is 10-20 times more common in patients with diabetes compared to those without.
The defining feature of a multidisciplinary approach to Charcot Foot and Ankle care is also its main benefit: promotion of a holistic view of the patient. According to the IDF, the support of a multidisciplinary team can reduce foot complications - such as chronic ulceration and amputations - up to 85%. The timely assessment and diagnosis of wounds, as well as the appropriate methods of prevention and treatment, are paramount to improved evidence-based outcomes, such as:
- Increased limb salvage, as a result of a 68% increase in angioplasty and 9% increase in bypass operations
- 62% reduction in major amputations
- 12% reduction in hospitalization for diabetes-related foot complications
- 20% reduction in overall amputations
To improve patient outcomes, one must understand the complex relationship between poorly controlled diabetes, vascular compromise, bone deformity, diabetic foot infection and other comorbidities. This is why there should be at least three levels of foot-care management with interdisciplinary specialists, and at least one member available for consultation or patient assessment at all times, according to guidelines from the International Working Group on the Diabetic Foot (IWGDF).
While the coordinating role in multidisciplinary teams should fall to the podiatrist (foot specialist) and the diabetologist, there are other professionals included in the multidisciplinary team:
- Vascular surgeons
- Endovascular interventionists/radiologists
- Diabetes nurses
- Surgeons (particularly a Charcot Foot surgeon)
- Infectious disease specialists/clinical microbiologists
- Pedorthists/orthotists
- Imaging professionals
All of these professionals should work in close cooperation and keep a close relationship with the patient to ensure proper management and swift recognition of complications in patients with suspected Charcot Foot and Ankle.
Keeping the patient involved
Awareness and proper management are keys to ensure a timely diagnosis of Charcot Foot and Ankle. The multidisciplinary team is important, but the patient also plays a critical role in preventing complications and seeking prompt medical care when needed.
Patients are encouraged to inspect foot skin and nails daily, schedule regular foot check-ups, and be especially attentive to signs of ulceration. Understanding how Charcot Foot and Ankle progresses and the possible complications can encourage patients to take an active role in the management of their condition, greatly improving outcomes. Since the active, initial stage is driven by a state of inflammation, it is up to the patient to maintain vigilance regarding feet care.
By involving patients in the management of their disease and creating a good rapport with all the members of the multidisciplinary team, there is the potential to improve outcomes, especially limb salvage.
If you would like to know more about Charcot Foot and Ankle treatment, you can watch this recorded webinar.
References
- IWGDF Guidelines on the prevention and management of diabetic foot disease. 2019.
- https://www.hmpgloballearningnetwork.com/site/podiatry/multidisciplinary-team-approach-diabetic-foot. Last access: September 2021.
- https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/amputation-and-diabetes/art-20048262. Last access: September 2021.
- Arshad K et al. Endocrinol Metab Int J 2017, 5(2): 00119
- Khrishan et al. Diabetes Care 2008 Jan; 31(1): 99-101
