Abstract
Introduction: Charcot’s neuroarthropathy is a degenerative disease with an important inflammatory component; it is multifactorial, but a higher prevalence has been observed in diabetic neuropathy. There are several stages and it can occur in every joint of the body, those of the foot and ankle segment are the most functionally and structurally affected; the deformities are closely related to load causing ulcers and sometimes ending in amputations. Treatment is based on modifying the natural history of the disease and reducing the risk of amputation. The Caldiño method is a Charcot treatment algorithm which consists on applying serial total contact corrective casts (TCCC) as a nonsurgical or pre surgical treatment in cases of instability and deformities of the foot and ankle for a period of approximately 3 months.
Objective: To demonstrate the importance of the use of total contact corrective cast (TCCC) as essential element in the treatment of Charcot arthropathy, the application technique and present the casuistry of patients under the use of the Caldiño Method in the hospital during a period of 20 years.
Material and methods: Retrospective review of the casuistry of the Orthopedics Hospital in the foot and ankle service from 2003 to 2023 of patients diagnosed with Charcot neuroarthro- pathy who were treated under the Caldiño Method for the application of TCCC. A total of 412 medical records of patients seen during this period were identified.
Results: 401 patients with a mean age of 59.5 were included, 68.3% (274 p) were males; the most affected foot was the left (63%). Type 2 diabetes predominated in 85% of the cases,. 54% of the cases were diagnosed at stage 2 Eichenholtz On average 3 casts were applied, 3.5% of patients presented with minor complications and in 21% the TCCC was used as pre-surgical treatment.
During Follow-up we evaluated the need for reapplication of TCCC or the need for partial support orthosis to achieve an adequate gait.
Discussion: The TCCC is a key procedure in the treatment of patients with neuropathic arthropathy if used in a timely manner, as it maintains an aligned foot, free of contact pressure deformities during the unloading stage of treatment. In patients with significant and unstable deformities that require surgical treatment, the use of pre surgical TCCC showed good bone preservation, small bone resections during surgery or the possibility of performing minimally invasive surgeries.
Conclusions: In our experience, the use of total contact corrective casts following the Caldiño method is an essential procedure for treating patients with long-standing diabetic neuropathy and advanced stages of Charcot neuroarthro- pathy.
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