Health-Care Disparities with Charcot's Neuroarthropathy

Minority disparities have been documented in the diabetic community since the late 1990s. Historically, the literature acknowledges that higher rates of diabetes-related complications occur in this subgroup. Despite this, disparities among patients with Charcot's neuroarthropathy have yet to be explored. We compared incidence and management among patients with Charcot's neuroarthropathy with emphasis on racial and geographic differences.

We retrospectively reviewed patients from two hospitals, an inner-city tertiary center and a suburban facility, between 2013 and 2022. Patients were managed by the same attending physician as either referrals or initial consultations for a diagnosis of Charcot's neuroarthropathy of the foot and ankle. Patient selection was performed via International Classification of Diseases, 10th Revision codes associated with Charcot's joint of the foot.

Of 120 patients identified, 87.5% were nonminority white individuals. The minority community had an increased frequency of medical comorbidities. Minorities were two times more likely to undergo a staged reconstruction. Compared with suburban patients, inner-city patients, on average, had higher hemoglobin A1c levels and more ulceration and osteomyelitis. Similarly, this cohort was more apt to undergo reconstructive surgery and had a reduced mortality rate.

Although there may be a correlation with medical comorbidities in minority communities, there does not seem to be a difference in the management of Charcot's neuroarthropathy. Location has the potential to play a role in diagnosis, management, and potential outcomes, likely due to access to health care and community education. More prospective studies are warranted to better understand the influence of racial and geographic differences on management of the Charcot foot.