Casting a Path to Improved Outcomes: The Crucial Role of Total Contact Corrective Casts in Charcot Neuroarthropathy Treatment

Introduction: Charcot's neuroarthropathy is a degenerative disease with an important inflammatory component. It is a multifactorial pathology, but a higher prevalence has been observed in diabetic neuropathy. There are several stages and it can occur in all joints, those of the foot and ankle segment are the most functionally and structurally affected; the deformities are closely related to load causing ulcers and these amputations. Treatment is based on modifying the natural history of the disease and reducing the risk of amputation, following the Charcot treatment algorithm that uses the Caldiño method. This method bases the treatment on total contact corrective casts(TCCC) as conservative and preoperative treatment in cases of instability and deformities for a period of approximately 3 months. Objective: To present the importance of the use of total contact corrective cast in the treatment of Charcot arthropathy, the application technique and to describe 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 neuroarthropathy 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, with a predominance of 68.3% of the male gender (274 patients); the most affected foot was the left for both sexes (63%). Type 2 diabetes mellitus predominated in 85% of the cases, the average time of evolution of diabetes mellitus was 17.2 years until
seeking medical attention for Charcot neuroarthropathy. 54% of the cases were diagnosed with Eichenholtz Stage 2 at their first consultation. On average 3 casts were placed. 3.5% presented minor complications and in 21% the total contact corrective plaster was used as pre-surgical preparation. For follow-up, the reapplication of total contact casts and the start of walking with partial support with orthosis is contemplated . Discussion: The total contact corrective cast is a key procedure in the treatment of patients with neuropathic arthropathy, as it allows an aligned foot, free of hyperpressive deformities if used in a timely manner with unloading. In the case of patients with significant and unstable deformities that require surgical treatment, it allows bone preservation, small bone resections or minimally invasive surgeries. Conclusions: In our experience, the use of total contact corrective cast under the Caldiño method is the indicated therapeutic option for patients with long-standing diabetic neuropathy and advanced stages of Charcot neuroarthropathy.

Article file ID not found.

The authors declare no conflict of interest.

Not applicable

The datasets used in this study are openly available at [repository link] and the source code is available on GitHub at [GitHub link].

This work did not receive any external funding.