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How should the diabetic Charcot foot be off-loaded?

Three Part Question

In a [diabetic patient with Charcot's arthropathy] are [instant total contact casts (iTCCs) or traditional total contact casts (TCCs) better] at [reducing joint destruction?]

Clinical Scenario

A 54 year old male with diabetes and peripheral neuropathy presented to the Emergency department with a hot, swollen, red left foot. He was investigated and found to have Charcots arthropathy. You know the best way to prevent further joint destruction is to off-load the foot but wonder what is they best way to achieve this.

Search Strategy

(exp diabetes mellitus OR exp diabetic neuropathies OR exp diabetic foot OR exp arthropathy) AND (total contact OR OR removable cast OR LIMIT to humans and English language
Medline from 1950 to June 2007 using the Ovid interface and Embase from 1996 to week 25 2007

Search Outcome

No relevant articles were found

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses


Although there were no studies which specifically looked at which was the better way to offload the Charcot foot there was a lot of evidence regarding off-loading in general being good for the Charcot foot (e.g. McGill et al) There was also plenty of evidence about the best method of off-loading the diabetic foot ulcer. Seen as ulceration and Charcot's changes both heal due to a reduction in pressure to the area it is logical to assume that the off-loading method most effective at healing ulceration will also be the method most effective at curing Charcot's arthropathy. Beacuse of this another BET (the best method to off-load diabetic foot ulceration) was conducted to see which off-loading method was preferable in diabetic foot ulceration.

Clinical Bottom Line

The diabetic Charcot foot should be off-loaded, unfortunately, there is no evidence to support iTTCs being superior to TCCs at reducing joint destruction. There is evidence, however, to support iTCC being better at healing ulceration and therefore being the best off-loading device.


  1. McGill M, Molyneaux L, Bolton T, Ioannou K, Uren R, Yue DK. Response of Charcot's arthropathy to contact casting: assessment by quantitative techniques Diabetologia 2000;43:481-4