Diabetic Nephropathy but not HbA1c is Predictive for Frequent Complications of Charcot Feet - Long-term follow-up of 164 Consecutive Patients with 195 Acute Charcot Feet

Aims: To investigate the clinical characteristics, treatment and long-term outcome of patients with acute Charcot feet (CF). Methods: Single-center retrospective analysis. Treatment of CF: stage-dependent immobilization/weight-off therapy, orthopaedic/adjusted shoes, foot surgery. 164 consecutive participants (type 1 vs. type 2 diabetes): 12 vs. 150, non-diabetic peripheral neuropathy: n = 2, presented with 195 (17 vs. 176) CF. Mean follow-up: 4.7 +/- 2.5 (range 2.2-9.8) vs. 5.4 +/- 2.9 (range 0.8-18.8) years, vital at follow-up: 100 vs. 88%. Results: Baseline characteristics: age: 43.7 +/- 10.9 vs. 57.9 +/- 8.9 years (p < 0.001), male gender: 66.7 vs. 77.3%, diabetes duration: 19.2 +/- 9.1 vs. 13 +/- 8.6 years (p = 0.018), GHb: 8.1 +/- 2.4 vs. 7.6 +/- 1.6%, BMI: 24 +/- 5.3 vs. 33.7 +/- 6.5 kg/m(2) (p < 0.001), Levine 1: 18.2 vs. 7.4%, Levine 2: 45.5 vs. 65.9%, Sanders 2: 58.3 vs. 68.5%, Sanders 3: 33.3 vs. 45%. Therapy: immobilization for 6 +/- 4.2 vs. 5.4 +/- 4.5 months, orthopaedic/adjusted shoes: 27.3 vs. 20.5%, foot surgery: 11.8 vs. 18.2%. Major complications: 50 vs. 56% (rocker bottom deformities: 23.5 vs. 46.3%, foot ulcerations: 17.6 vs. 24.6%, CF amputations: 0 vs. 6%), not CF amputations: 16.7 vs. 15.3%, second episodes of CF: 41.6 vs. 18.3% after 5-132months. Diabetic nephropathy was associated with an increase, intensive antihypertensive therapy with a decrease of complications. Conclusions: Patients with CF are middle-aged, overweight males with type 2 diabetes above 10 years. Patients with type 1 diabetes are younger, have normal BMI and longer diabetes duration. Major complications and second episodes of CF are frequent. Diabetic nephropathy could be a risk factor for CF related complications. The awareness for CF must be improved. The study was conducted due to the Declaration of Helsinki.