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Bone Mineral Density During Total Contact Cast Immobilization for a Patient With Neuropathic (Charcot) Arthropathy

MK Hastings, PT, DPT, ATC, is Instructor, Program in Physical Therapy, School of Medicine, Washington University, St Louis, MO 63110 (USA) (hastingsm{at}msnotes.wustl.edu)
DR Sinacore, PT, PhD, is Associate Professor, Program in Physical Therapy, School of Medicine, Washington University
FA Fielder, RN, BC, ANP, is Nurse Coordinator, Department of Orthopaedic Surgery, School of Medicine, Washington University
JE Johnson, MD, is Associate Professor and Chief, Foot & Ankle Service, Department of Orthopaedic Surgery, School of Medicine, Washington University
Dr Hastings, Dr Sinacore, and Dr Johnson provided concept/idea/project design. All authors provided writing and consultation (including review of manuscript before submission). Dr Hastings, Dr Sinacore, and Ms Fielder provided data collection, and Dr Hastings and Dr Sinacore provided data analysis. Dr Hastings and Dr Sinacore provided project management. Dr Sinacore provided fund procurement. Ms Fielder provided the patient. Dr Sinacore and Ms Fielder provided facilities/equipment. The authors thank Bob Koger, BS, for assistance in data collection and Dwight A Towler, MD, PhD, from the Division of Bone and Mineral Diseases at Washington University School of Medicine for the use of the bone sonometer

Address all correspondence to Dr Hastings

Background and Purpose. Diabetes mellitus (DM)-related neuropathic arthropathy of the foot is a destructive bone and joint process. The effect of cast immobilization and non-weight bearing on bone loss has not been well studied. The purpose of this case report is to describe the changes in bone mineral density (BMD) of the calcaneus in the feet of a patient with acute neuropathic arthropathy during total contact cast immobilization. Case Description. The patient was a 34-year-old woman with type 1 DM, renal failure requiring dialysis, and a 7-week duration of neuropathic arthropathy of the midfoot. Intervention included total contact casting and minimal to no weight bearing for 10 weeks, with transition to therapeutic footwear. Ultrasound-derived estimates of BMD were taken of both involved and uninvolved calcanei. Outcome. Bone mineral density decreased for the involved foot (from 0.25 g/cm² to 0.20 g/cm²) and increased for the uninvolved foot (from 0.27 g/cm² to 0.31 g/cm²) during casting. Discussion. The low initial BMD and further loss during casting suggest the need for transitional bracing and a well-monitored return to full activity to minimize the risk of recurrence and progression of foot deformity.

Key Words: Arthropathy • Diabetes mellitus • Foot diseases • Fractures, neurogenic

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