Usefulness of a brief assessment battery for early detection of Charcot foot deformity in patients with diabetes.

Charcot neuroarthropathy is a significant limb-threatening complication that develops in some patients with long-term diabetes mellitus. Early diagnosis is vital to secondary prevention of the destructive process and avoidance of consequent deformity and, ultimately, amputation. The purpose of this study was to determine which historical and physical findings would be more accurate risk factor indicators in those diabetics with and without Charcot foot deformity. A controlled series of tests, historical findings, and physical examinations were performed on 41 patients with diabetes who were Charcot-free and 18 patients with diabetes with known chronic CD of the foot by using inexpensive hand-held instruments in a clinical setting. Physical examination included evaluation of vascular and neurologic characteristics. Historical findings consisted of those normally elicited from systems review or past medical history. The results indicate that simple neurologic testing combined with a thorough patient history were the most beneficial tools to determine diabetics with a higher probability of developing CD. Specifically, history of retinopathy (P <.02), nephropathy (P <.003), and previous foot ulcer (P <.01) were found to be predictive. The neurologic findings of vibratory sensation (P <.001), deep tendon reflexes (P <.05), and the 5.07 (10 g) Semmes-Weinstein monofilament test (P <.001) were also highly correlative for the development of Charcot foot deformity. Vascular examinations were found to differentiate poorly between groups. The application of this data may provide for earlier detection of Charcot arthropathy based on the predictive capabilities.