Download Charcot foot in diabetes * evidence based care pathway

CHARCOT FOOT IN DIABETES – EVIDENCE BASED CARE PATHWAY
SUSPECTED ACUTE CHARCOT FOOT
Consider Charcot in any patient with diabetes (and neuropathy)
with hot/swollen foot
If suspected, refer for urgent
assessment in Specialist Foot clinic
[email protected]
BASELINE ASSESSMENT
Full foot examination (and clinical photo)
Document foot temperature differential
Routine bloods – FBC, ESR, CRP, U&E, HbA1c
Plain X-ray
Positive X-ray
OFFLOADING
Proceed with off-loading either with
Total contact cast (remove and reassess
at 3-5days and 1-2weekly thereafter)
Or
Removable Air Cast Walker (reassess
at 1-week and 1-2weekly thereafter)
Effective
After consolidation,
prescription footwear
and follow up
Ineffective
Consider Bisphosphonates
and/or surgical
management
Negative X-ray
FURTHER IMAGING
(Proceed with off-loading pending results
of investigations)
MRI - preferred (especially if concomitant
ulcer or infection considered) or
Isotope bone scan (if MRI unsuitable or
infection considered unlikely); may need
additional labelled WCC scan if infection
considered
Positive
Negative
Charcot foot
unlikely
Osteomyelitis
likely
Treat
Osteomyelitis