Casting is a Cost-Effective Management Option in Appropriate Cases of Charcot Neuroarthropathy

Abstract

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot Neuroarthropathy (CN) is a chronic and debilitating condition that impacts the nerves of the foot. The progression of CN may result in severe joint deformities, ulcers, and amputation in certain cases. Treatment options for CN include surgical interventions (e.g., arthrodesis, exostectomy, and amputation) and non-surgical interventions (e.g., casting). A cost analysis on the various treatment modalities can guide physicians to help their patients make informed decisions about their care. Here, we aim to characterize the total costs associated with the various treatments of CN, in addition to the physical therapy (PT) related costs. Methods: Following IRB approval, a sample of patients at a single institution diagnosed with CN of the lower extremity, who underwent exostectomy, arthrodesis, amputation, and/or casting were identified through patient records. Various demographics such as age, sex, and race were collected. Individuals were placed in their respective categories based on the first procedure they had performed. The groups were divided as follows: exostectomy, arthrodesis, major amputation, minor amputation, casting, and failed casting (the group that first received casting but later needed further intervention with other treatment modalities). Each procedure and PT appointment was counted toward the total cost. Descriptive statistics, t-tests, and one-way ANOVA were performed for statistical analysis. Results: Two-hundred and sixteen patients were identified; exostectomy (n = 81), arthrodesis (n = 47), major amputations (n = 10), minor amputations (n = 28), failed casting (n = 16), and casting (n = 34). The average age was 58 ± 12.1 years, and males accounted for 54% of the sample size with the various demographic information depicted in table 1. The effect of procedure type on total cost demonstrated a statistically significant difference between at least two groups (F-value = 18.53, p-value < 0.01), as demonstrated in figure 1. The total costs for casting were significantly lower than all other treatment modalities (p-value < 0.05). Furthermore, there was no statistical significance related to physical therapy costs among the groups (figure 2). Conclusion: Casting was demonstrated to be a more cost-effective management strategy for patients diagnosed with CN. However, it is important to note that this cost-related benefit is only apparent when CN patients are appropriately treated with casting, exemplified by the failed casting group. It is critical to utilize casting with appropriate patients in order to reduce the cost burden associated with these various management modalities. Early surgical intervention should still be strongly considered for patients who are not appropriate candidates for casting.