علاج مفصل شاركو في اعتلال العظام العصبي غير المستقر في القدم — نوع سانديرز-فريكبرغ IV أو V أو تدمير العظام المتقدم مع عدم استقرار المفصل

References

DOI: 10.1007/s40266-025-01234-0

• Patients suffering from unstable CNO of Sanders-Frykberg types I-III, stable Sanders-Frykberg type IV, V or more advanced CNO destructions are empirically treated by Sarmiento orthoses-dynamic or non-dynamic.
• In some cases, however there is more advanced destruction of the foot combined with joints instability and not so rarely with diabetic foot ulcers and osteomyelitis.
• Dynamic Sarmiento orthoses completely offload the main weight bearing structures such as the talus, calcaneus, ankle joint or the whole foot.
• Non-dynamic Sarmiento orthoses, known as the Patellar Tendon Bearing (PTB) castings have also emerged as an effective offloading method, particularly for Charcot foot complicated by diabetic foot ulcers.
• Empirically, we recommend stabilizing the foot by a combination of a special contact splint with wheelchair.
• 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.