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Health related quality of life in patients with Charcot arthropathy of the foot and ankle
Michael P. Sochocki, Shawn Verity, Pamela J. Atherton, Jefrey L. Huntington, Jeff A. Sloan, John M. Embil and Elly Trepman Foot and Ankle Surgery; Volume 14, Issue 1, 2008, Pages 11-15
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Background
Clinical observation suggests that Charcot arthropathy of the foot and ankle has major negative consequences on the quality of life of neuropathic patients, particularly those with diabetes. We hypothesized that the quality of life in patients with Charcot arthropathy may be aggravated by Aboriginal ethnicity and rural residence because of limited access to timely specialty healthcare.
Methods
Sixty patients with Charcot arthropathy were interviewed with the Short Form 36 (SF-36) Health Survey.
Results
Mean Physical Component Summary (PCS) score was 31 ± 8 points and mean Mental Component Summary (MCS) score was 45 ± 10 points. Mean PCS and MCS scores were not affected by gender, ethnicity, residence, or Charcot stage. Mean PCS score was significantly lower in non-employed (unemployed or retired) than employed patients and in patients who did not use alcohol than those who used alcohol; MCS score was not affected by employment status or alcohol use.
Conclusions
Charcot arthropathy has a major negative effect on quality of life. The SF-36 survey was sensitive to the physical effects, but not to mental effects, of Charcot arthropathy.
Objective: To compare mortality risks of patients with Charcot arthropathy to those with diabetic foot ulcer and those with diabetes alone (no ulcer or Charcot arthropathy).
Research design and methods: A retrospective cohort of 1,050 patients with incident Charcot arthropathy in 2003 in a large healthcare system was compared to patients with foot ulcer and those with diabetes alone. Mortality was determined during a 5-year follow-up period. Charcot arthropathy patients were matched to individuals in the other two groups using propensity score matching based on patient age, sex, race, marital status, diabetes duration, and diabetes control.
Results: During follow-up 28.07% of the sample died; 18.8% with diabetes only and 37.0% with foot ulcer died compared to 28.3% with Charcot arthropathy. Multivariable Cox regression shows that, compared with Charcot arthropathy, foot ulcer was associated with 35% higher mortality risk (HR =; 1.35; 95% CI, 1.18 – 1.54) and diabetes alone with 23% lower risk (HR = 0.77; 95% CI, 0.66 – 0.90). Of the Charcot arthropathy patients, 63% experienced foot ulceration before or after the Charcot onset. Stratified analyses suggest that Charcot arthropathy is associated with significantly increased mortality risk independent of foot ulcer and other co-morbidities.
Conclusions: Charcot arthropathy was significantly associated with higher mortality risk than diabetes alone and with lower risk than foot ulcer. Foot ulcer patients tended to have higher prevalence of peripheral vascular disease and macrovascular diseases than Charcot arthropathy patients. This may explain the difference in mortality risks between the two groups.
Background
There is only sparse scientific data about the long-term effects of the Charcot foot on patients’ lives and the clinical outcome. This study evaluates the long-term effects of diabetic Charcot foot.
Methods
A cross-sectional follow-up study of consecutive series of patients with Charcot foot referred to the University Hospital Diabetic Foot and Ankle Clinic between 1991 and 2002.
Results
Forty-one patients were referred with Charcot foot between 1991 and 2002. After an average follow-up of 8 years their overall mortality rate was 29% (12/41) and 29 patients (30 Charcot feet) have been followed more than 5 years. Sixty-seven percent of Charcot feet suffered at least one episode of ulceration and 50% (15/30) of affected feet had surgical treatment resulting in 29 operations. Simple exostectomy was successful in 62% of cases. The need for surgical management increased markedly 4 years after the diagnosis. Correct diagnosis within 3 months resulted in better functional outcome (AOFAS) and walking distance (p = 0.006 and p = 0.008, respectively). Lower SF-36 component scores in physical functioning, social functioning and general health perceptions were found when the study population was compared to the general population and chronically ill control subjects.
Conclusions
Diabetic Charcot foot decreases patient's physical functioning and general health but does not usually affect mental health. Surgical management is often required with an increase 4 years post-diagnosis. A delay of diagnosis of more than 3 months was found to adversely affect the quality of life and functional outcome.
Charcot arthropathy and quality of life
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