Diagnosis and Treatment of Adult Flatfoot. CHARCOT FOOT.

[Refer to Pathway #1]

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Source: Clinical Practice Guideline Adult Flatfoot Panel. Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg 2005 Mar-Apr;44(2):78-113. Diagnosis and Treatment of Adult Flatfoot CHARCOT FOOT SIGNIFICANT HISTORY *Onset of Morphologic Changes -Progressive / Static. -Erythema. -Swelling. *Trauma - Type, When, Repetitive. *Pain / Sensation. *Previous Ulcer &/or Charcot. *History of Diabetes. SIGNIFICANT FINDINGS Refer to Pathway #1 Dermatologic *Erythema. *Warmth. *Cellulitis. *Ulcer. Musculoskeletal *Swelling. *Deformity. *Joint Dislocation. Neurologic *Degree of neuropathy assessed by Semmes-Weinstein mono-filaments, vibratory, proprioception Vascular *Papable pedal pulses. *Swelling. *Serologic Tests -CBC Differential. -ESR. -Blood Glucose. -Hb A1c. *Bone Biopsy. *Bone Culture. Diagnostic Imaging *Plain Radiographs. *Imaging Studies. -CT. -MRI. -Bone Scan. Radiographic Findings *Joints/Bones involved. *Osteolysis. *Fractures. *Dislocation. *Soft tissue edema. *Vascular Calcifications. * Additional Diagnostic Procedures as Indicated Treatment of Acute Charcot *Absolute Restriction on Weight-Bearing -Crutches. -Wheelchair. *Immobilization c Splint, Cast or Removable Cast until hyperemia resolved. *Continue Immobilization 4-6 months until quiescence (Chronic). *Pharmacologic. *Bone Stimulation. Acute DIAGNOSIS Chronic Treatment of Chronic Charcot Foot Unstable *Bracing. *Extra Depth Shoes. *Custom Moulded Shoes. *Multiple density insoles. *Orthoses. Foot Stable *Supportive Measures. *Therapeutic Footwear. *Patient Education. *Periodic Evaluation to prevent recurrence. Convert to Stable Foot Once Quiescent Treat as Chronic Foot remains Unstable. Not responsive to special footwear or orthoses. Surgical Stabilization. If ulcer reccurs, treat appropriately, see Diabetes CPG Pathway #1 Refer PATHWAY 6 All copyrights are reserved by the American College of Foot and Ankle Surgeons.