Prevalence and patterns of Charcot Foot Arthropathy among adult diabetic patients at Mulago National Referral Hospital

Abstract

Background: Charcot foot arthropathy is a potentially limb threatening condition that leads to progressive destruction of the bones and joints in the neuropathic foot. Its main cause is diabetes mellitus which prevalence is increasing. The acute phase is often misdiagnosed thus leading to foot deformity, ulceration and increased risk of amputation. Early diagnosis and management of the acute phase is therefore imperative to avoid progression towards permanent foot deformity and its associated complications; but there is scarcity of baseline data in the published literature for Africa and no data for Mulago National Referral Hospital. The main objective was to determine the prevalence and patterns of Charcot foot arthropathy among adult diabetic patients. Methods: This was a cross sectional study that was carried in Mulago National Referral Hospital, Kampala, Uganda. One hundred patients with longstanding diabetes mellitus were consecutively recruited. Prevalence, radiological patterns and patient characteristics associated with Charcot foot arthropathy (age, diabetes duration, body mass index, history of foot trauma, history of foot surgery, peripheral neuropathy, weight bearing foot radiograph and glycosylated haemoglobin HbA1c) were studied after clinical, radiological and laboratory examinations. Descriptive statistics and regression methods were used. Results: The prevalence of Charcot foot arthropathy among patients with longstanding diabetes was 12% of which 33% (4 out of 12) were acute cases. Fifty percent of the lesions were in the forefoot and 50% in the midfoot. Fifty percent of lesions were at the developmental stage of the modified Eichenholtz classification, 25% at the healing stage, 17% at the inflammatory stage and 8% at the remodelling stage. An abnormal foot radiograph (pvalue 0.003) and a history of foot surgery (p-value 0.047) were significantly associated with Charcot foot arthropathy among patients with longstanding diabetes. Conclusion: The prevalence of Charcot foot arthropathy among patients with longstanding diabetes at Mulago National Referral Hospital is 12% of which 33% are acute cases. There is equal involvement of the forefoot and the midfoot. Most of the radiographic lesions are at the initial stages. An abnormal weight bearing foot radiographs and a history of foot surgery are predictors of Charcot foot arthropathy. Clinicians in referral hospitals must be made aware of the extent of this condition and the need to implement policies to reduce the risk of amputation.