Charcot Neuro-Osteoarthropathy: A new Risk Class is Needed?

Area of Science:

• Diabetology
• Podiatry
• Vascular Surgery

Background:

• The International Working Group of Diabetic Foot (IWGDF) 2023 system lacks explicit risk stratification for Charcot neuro-osteoarthropathy (CNO).
• Chronic CNO may represent a distinct high-risk phenotype for diabetic foot ulcer recurrence.

Purpose of the Study:

• To determine if post-remission (chronic) CNO identifies a high-risk recurrence phenotype compared to IWGDF risk class 3.
• To assess if intensified podiatry surveillance improves outcomes in chronic CNO patients.

Main Methods:

• Prospective, single-centre observational study (2023-2024).
• Comparison of IWGDF class 3 patients without CNO (n=184) versus chronic CNO patients (n=27), all ulcer-free at baseline.
• Follow-up at 1-3 month intervals (Year 1) and intensified <=30-day intervals for CNO patients (Year 2).

Main Results:

• Chronic CNO patients exhibited higher re-ulceration (70.4% vs 33.1%) and amputation (18.5% vs 7.6%) rates in Year 1 compared to IWGDF class 3.
• Intensified surveillance in Year 2 markedly reduced re-ulceration in CNO patients (18.5% vs 70.4%).
• Trends towards fewer amputations and revascularizations were observed with intensified surveillance.

Conclusions:

• Chronic CNO represents a distinct high-risk recurrence phenotype not fully addressed by current IWGDF risk stratification.
• Findings support evaluating CNO-specific surveillance strategies.
• Consideration of CNO as a separate risk stratum within the IWGDF framework is warranted.