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Mortality associated with acute Charcot foot and neuropathic foot ulceration
Juliette van Baal1, Richard Hubbard, Fran Game
1Foot Ulcer Trials Unit, Nottingham University Hospitals Trust, City Hospital Campus, Nottingham, UK.
Insights
Patients with acute Charcot foot and uninfected neuropathic foot ulcers (NFUs) face unexpectedly high mortality rates. Survival is significantly reduced compared to the general UK population, highlighting a critical public health concern.
Area of Science:
- Diabetology
- Podiatry
- Public Health
Background:
- The Charcot foot is a serious complication of diabetic neuropathy.
- Neuropathic foot ulcers (NFUs) are common in diabetic patients.
- Mortality associated with these conditions requires further investigation.
Purpose of the Study:
- To compare mortality rates between patients with acute Charcot foot and a matched cohort with uninfected neuropathic foot ulcers (NFUs).
- To assess long-term survival of these patient groups against normative UK population data.
Main Methods:
- Retrospective data extraction from a specialist database and hospital records.
- Matched cohort study comparing acute Charcot foot patients with uninfected NFUs.
- Comparison of survival data with UK population mortality statistics.
Main Results:
- No significant difference in survival was observed between acute Charcot foot patients and the NFU control group.
- Median survival for acute Charcot foot patients (1980-2007) was 7.88 years, not significantly different from NFU controls (8.43 years).
- Both groups experienced a reduced life expectancy of approximately 14 years compared to the general UK population.
Conclusions:
- Mortality in patients with acute Charcot foot and uninfected neuropathic foot ulcers is unexpectedly high.
- These conditions significantly impact long-term survival.
- Further research into risk factors and interventions is warranted.
Objective:
To compare the mortality of patients with an acute Charcot foot with a matched population with uninfected neuropathic foot ulcers (NFUs).
Research Design And Methods:
Data were extracted from a specialist departmental database, supplemented by hospital records. The findings were compared with the results of earlier populations with Charcot foot and uninfected NFUs managed from 1980. Finally, the results of all patients with acute Charcot foot and all control subjects managed between 1980 and 2007 were compared with normative mortality data for the U.K. population.
Results:
A total of 70 patients presented with an acute Charcot foot (mean age 57.4 +/- 12.0 years; 48 male [68.6%]) between 2001 and 2007; there were 66 matched control subjects. By 1 October 2008, 13 (eight male; 18.6%) patients with a Charcot foot had died, after a median of 2.1 years (interquartile range 1.1-3.3). Twenty-two (20 male; 33.3%) control subjects had also died after a median of 1.3 years (0.6-2.5). There was no difference in survival between the two groups (log-rank P > 0.05). Median survival of all 117 patients with acute Charcot foot managed between 1980 and 2007 was 7.88 years (4.0-15.4) and was not significantly different from the control NFU patients (8.43 years [3.4-15.8]). When compared with normative U.K. population data, life expectancy in the two groups was reduced by 14.4 and 13.9 years, respectively.
Conclusions:
These data confirm that the mortality in patients presenting to our unit with either an acute Charcot foot and an uninfected neuropathic ulcer was unexpectedly high.
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