Charcot foot in a Hong Kong Chinese diabetic population

HB Leung, YC Ho, WC Wong
Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong

OBJECTIVES. To delineate the epidemiology of Charcot foot in Hong Kong Chinese diabetic patients, and to provide baseline data for benchmarking the clinic service for this special group of patients.

DESIGN. Retrospective cohort study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. Diabetic patients with Charcot foot and age- and sex-matched diabetic foot clinic attendees between 1995 and 2007.

MAIN OUTCOME MEASURES. Clinical presentations were compared in patients with Charcot foot and the controls.

RESULTS. Twenty-five patients were diagnosed with Charcot foot over 12 years; 60% were male. At the time of diagnosis, the mean age was 59 (standard deviation, 14; range, 38-85) years, with diabetes being diagnosed for a mean of 11 (standard deviation, 8; range, 0-30) years. Retinopathy was noted in 36% (n=9) and nephropathy in 20% (n=5) of the Charcot foot patients. No patient had peripheral vascular disease. This finding was statistically significant. Delayed presentation occurred in 11 patients. Presentation was usually unilateral. In the minority (n=3, 12%) with bilateral involvement, presentation was sequential. Charcot arthropathy affected the mid-foot in 64% of the patients. Superimposed infection was common (61%). Recurrent ulceration occurred in 11%, all of whom presented late. Only one patient underwent major amputation, but the 5-year mortality of Charcot foot patients could be up to 33%.

CONCLUSION. Charcot foot was uncommon in this population. Late presentation was common and might be related to superimposed infection; such patients were prone to recurrent ulcers.

Hong Kong Med J 2009;15:191-5

Key words: Arthropathy, neurogenic; Diabetic foot; Diabetic neuropathies; Foot ulcer