علاج مفصل شاركو النشط: بروتوكول الخط الأول المنظم

References

DOI: 10.1007/s40266-025-01234-0

• These guidelines recommend immobilization as the primary intervention, with total contact casting (TCC) representing the gold standard treatment.
• Initial TCC should be removed and recast after seven days owing to significant reduction in swelling, followed by reviews every 1-2 weeks to reassess infrared dermal temperatures for improvement of the foot clinically and to monitor cast fit.
• The general approach to treating Charcot foot involves an initial phase of strict immobilization and non-weight-bearing, typically using a TCC or specialized boot, to reduce inflammation, prevent further deformity and allow bone healing.
• Principally, irremovable knee-high orthoses should be as effective as TCC.
• Treatment of CNO includes immobilization, offloading, recalcification (supplementation of vitamin D and calcium) and in the most advanced cases, surgical treatment.
• The average management time ranges from 2 to 12 months, with confirmed inactive Charcot diagnosis indicated by complete resolution of clinical signs/symptoms, temperature difference less than 2 degrees C at corresponding locations for 4-6 consecutive weeks, and weight-bearing x-rays confirming the remodelling phase.
• Modern diagnostic approaches increasingly incorporate temperature assessment (especially self-evaluation at home), with a temperature difference of less than 2 degrees C between corresponding locations on the two feet for 4-6 consecutive weeks serving as a criterion for inactive disease.