Offloading Interventions for the Management of Charcot Neuroarthropathy in Diabetes

Published by M-Med | Educational content for wound care professionals

This 2025 retrospective cohort study evaluated the effectiveness of various offloading interventions in the management of Charcot neuroarthropathy (CA) with associated diabetic foot ulcers (DFUs). Conducted at the Royal Darwin Hospital's multidisciplinary foot clinic in Australia, the study analyzed 93 cases of CA treated between January 2003 and June 2015. The primary focus was on the use of nonremovable patellar tendon-bearing (PTB) casts compared to custom-made removable devices.

Key Findings

Among the 93 patients, 76 were treated with PTB casts, while 17 received custom-made removable devices. Patients in the PTB cast group were allowed to fully weightbear on the affected limb, as tolerated. Initial offloading continued until joint stabilization and ulcer healing, averaging 6.5 ± 1.9 months. Subsequently, patients transitioned to various orthotic devices and then to accommodative footwear. The total duration of offloading treatment had a median of 13.1 months (range 10–24 months). Patients initially treated with PTB casts demonstrated better outcomes compared to those treated with removable devices.

Clinical Implications

The study concludes that immobilization using PTB casting is an effective offloading method for managing CA with DFUs. Notably, the outcomes were similar between Indigenous and non-Indigenous patients, suggesting the approach's applicability across diverse populations. The findings support the use of PTB casts as a viable option in settings with limited resources and highlight the importance of individualized offloading strategies in the management of CA.