A Retrospective Comparison of Orthotic Interventions on Charcot Feet

IntroductionThis retrospective chart review aims to find evidence supporting a difference in complications rates and progression of Charcot deformity between two orthotic interventions: the CROW and the custom calf lacer ankle foot orthosis. The existing evidence base to support the use of orthoses in the prevention and treatment of diabetic foot ulcers secondary to Charcot arthropathy is extremely limited.MethodsSubjects were diagnosed with diabetes mellitus and Charcot arthropathy and referred for orthotic treatment. A billing audit of subjects treated between September 1, 2018, and May 1, 2020, was generated using L codes L2330 and L4631.Subjects were excluded if they received a midfoot or higher amputation before application of the offloading device. In total, 87 charts were retrospectively reviewed, and 47 subjects were included.MethodsSubjects were diagnosed with diabetes mellitus and Charcot arthropathy and referred for orthotic treatment. A billing audit of subjects treated between September 1, 2018, and May 1, 2020, was generated using L codes L2330 and L4631.Subjects were excluded if they received a midfoot or higher amputation before application of the offloading device. In total, 87 charts were retrospectively reviewed, and 47 subjects were included.ResultsNo significant difference was found in complication rate between the two groups. The first year of orthotic intervention had the highest number of complications for both devices. In addition, most calf lacer subjects wore the orthosis for 2 to 3 years, whereas most CROW subjects wore the orthosis for 2 years.ConclusionsThese findings suggest that both orthotic interventions available to treat diabetic foot ulcers secondary to Charcot arthropathy have similar complication rates. More research is needed to determine the clinical benefits of prescribing one intervention over the other.Clinical RelevanceAlthough clinical empirical evidence suggests lower complication rates with the use of calf lacer AFOs, this study found no statistical difference in the overall number of complications observed with the two orthotic interventions.