Ahmed M A Kensarah
King Abdulaziz University Hospital, Saudi Arabia
Ahmed Mohamed Arif Kensarah has been Graduated from Cairo University, Egypt as a Medical Doctor. Later on he obtained his post-graduation from Royal College of Surgeons in Edinburgh with subjects F.R.C.S. Ed and then started working at King Abdul Aziz University, Department of Surgery, where he has continued his research. Presently he has been working at Al Mashfa Hospital in Jeddah.
Aim: The aim is to evaluate foot Charcot's neuroarthropathy in diabetics in at tertiary hospitals in Jeddah (KSA). The study is a retrospective one, completed at the Surgical Department of King Abdulaziz University Hospital from 2005 – 2015 inclusive (64 patients in 11 years, mean age 61.75 years with male/female ratio 4:1.). The study items were: patient demography, exact presenting symptoms, duration, type of diabetes present, presence of a history of trauma, deformity, ulcer, peripheral vascular disease, obesity, hypertension, and history of previous surgery. Decumented had also been the exact site of involvement (mid, hind or fore-foot) and any given treatment.
Results: Pain was reported in 25%, numbness 12.5%, deformity 23.4%, discharge 73.4%, and difficulty in walking in 12.5%.. Eleven percent of patients reported a history of trauma. Majority of patients (68.8 %) had their diabetes of the no-ninsulin dependent type lasting > 10 years. It was fully controlled in 21.9%.
Other Findings: Nephropathy 46.3%, neuropathy 59.4%, retinopathy 40.6%, cardiomyopathy 48.4% and vasculopathy in 56.3% of cases. Charcot arthropathy involved forefoot in 65.5%, midfoot 4.7% and hindfoot/ankle in 21.9% of cases. Insult present as proven by x-ray as: subluxation 40.6%, dislocation 54.7%, disorganization 42.2%, bone resorption 23.4%, osteomyelitis 14.1%, fractures 50%, and in 39.1%. Three quarters of patients required some sort of amputation, while debridement was sufficient for the rest.
Conclusions: Charcot joint in the feet of diabetics poses great challenge in management. Emphasis should be given for early detection and prompt treatment, to be tailored according to the lesion.