Charcot Restraint Orthotic Walker

Abstract

Five patients (three with insulin dependent diabetes mellitus (IDDM), one with noninsulin dependent diabetes mettlitus (NIDDM), and one with hereditary sensorimotor neuropathy (HSMN)) with stage 1 Charcot's neuroarthropathy involving the midfoot and or subtalar and ankle joints were fitted with a Charcot restraint orthotic walker (CROW). The rationale for this orthotic management was to maintain a plantigrade foot for ambulation and to protect the joints and skin by the uniform transfer or distribution of weight over the foot until the time when the pathology reached the stage of coalescence. The patients were able to fully bear weight and to ambulate with the CROW. All patients noted varying measures of improvement in symptoms and function at an average 12-month follow-up. The CROW is a useful orthosis in the armamentarium for treating neuroarthropathy of the pedal joints.

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References

1. Baumhauer

J. F.

Wervey

McWilliams

Harris

G. F.

Shereff

M. J.

: A comparison study of plantar foot pressure in a standardized shoe, total contact cast, and prefabricated pneumatic walking brace. Foot Ankle Int., 18: 26–33, 1997.

2. Boninger

M. L.

Leonard

J. A.

Jr. : Use of bivalved ankle-foot orthosis in neuropathic foot and ankle lesions. J. Rehabil. Res. Dev., 33: 16–22, 1996.

3. Brodsky

J. W.

: The diabetic foot. In Mann

R. A.

Coughlin

M. J.

(eds.), Surgery of the Foot and Ankle, 6th Ed. St. Louis, C. V. Mosby, 1993, pp. 925–944.

4. Clohisy

D. R.

Thompson

R. C.

: Fractures associated with neuropathic arthropathy in adults who have juvenile-onset diabetes. J. Bone Joint Surg., 70A: 1192–1200, 1988.

5. Conti

S. F.

Martin

R. L.

Chaytor

E. R.

Hughes

Luttrell

: Plantar pressure measurements during ambulation in weightbearing conventional short leg casts and total contact casts. Foot Ankle Int., 17: 464–469, 1996.

6. Eichenholtz

S. N.

: Charcot Joints. Springfield, IL, Charles C. Thomas, 1966.

7. Garrow

J. S.

: Obesity. In Weatherall

D. J.

Ledingham

J. C. G.

Warell

D. A.

(eds.), Oxford Textbook of Medicine, 3rd Ed., New York, Oxford University Press, 1996, pp. 1301–1314.

8. Giurini

J. M.

Chrzan

J. S.

Gibbons

G. W.

Habershaw

G. M.

: Charcot's disease in diabetic patients. Postgrad. Med., 89: 163–169, 1991.

9. Jernberger

: The neuropathic foot. Prosthet. Orthot. Int., 17: 189–195, 1993.

10.

10. Johnson

J. T. H.

: Neuropathic fractures and joint injuries: pathogenesis and rationale of prevention and treatment. J. Bone Joint Surg., 49A: 1–30, 1967.

11.

11. Jordan

W. R.

: Neuritic manifestations in diabetes mellitus. Arch. Intern. Med., 57: 307–366, 1936.

12.

12. Kitaoka

H. B.

Alexander

I. J.

Adelaar

R. S.

Nunley

J. A.

Myerson

M. S.

Sanders

: Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int., 15: 349–352, 1994.

13.

13. Martin

R. L.

Conti

S. F.

: Plantar pressure analysis of diabetic rockerbottom deformity in total contact casts. Foot Ankle Int., 17: 470–472, 1996.

14.

14. Marzano

: Bivalve AFO for Charcot osteoarthropathy. Biomechanics, 3: 5: 1–2, 1996.

15.

15. Morgan

J. M.

Biehl

W. C.

III Wagner

F. W.

: Management of neuropathic arthropathy with the Charcot Restraint Orthotic Walker. Clin. Orthop., 296: 58–63, 1993.

16.

16. Rang

: Charcot's Joints: Jean-Martin Charcot. In Anthology of Orthopaedics. Edinburgh, E8#x38;S Livingstone, 1966, pp. 42–47.