What is the treatment

Treatment consists in immobilization of the foot with the application of a plaster that includes the whole foot, except for the toes, up to the knee. The plaster should be changed every 2-3 weeks. There are no explicit guidelines for the time interval of immobilization, but a

Figure 17.9. Chronic recurrent neurotrophic ulcer on a foot with Charcot athropathy. The ulcer develops under an area with abnormal osseous protrusion in the middle of the foot. The foot arch has been destroyed.

criterion of successful treatment is the return of the temperature of the foot to a normal level. There are recent studies in small numbers of patients that show that the intravenous administration of bispho-sphonates has very good results in the treatment of acute Charcot arthropathy. One dose of pamidronate 60 mg (or even another bispho-sphonate in equivalent dose) intravenously causes a decrease of pain or the feeling of heaviness, amelioration of inflammation signs, and more rapid return of the temperature to the normal range. Moreover, the indicators of increased bone metabolism (bony fraction of alkaline phosphatase, urine dihydroxypyridoline) more quickly return to normal levels.

Figure 17.10. Significant deformity of the foot joints bilaterally due to bilateral Cahrcot arthropathy.
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