Monitoring of Charcot neuroarthropathy : a mixed methods, feasibility study

Background: Charcot neuroarthropathy (CN) is a serious complication of diabetes neuropathy which affects the lower limb. The best method to monitor disease progression and, diagnose remission is unknown. Magnetic resonance imaging (MRI) may be useful for monitoring disease, but this has not been evaluated. Furthermore, there is a lack of understanding about people's experiences of living with CN and receiving treatment. Aim: To investigate the feasibility of using serial MRI to monitor and diagnose remission in CN and to understand people's experiences of living with CN. Methods: A mixed methods approach was used: 1) a systematic review to assess the effectiveness of techniques for monitoring response to treatment in acute CN; 2) a multicentre, randomised, prospective, two arm, open feasibility study of using serial MRI to monitor CN; 3) a qualitative study to understand people's experiences of CN. Results: The systematic review showed multiple techniques to monitor response to treatment, but uncertainty remains about their effectiveness. Five sites participated in the feasibility study. Two-thirds of eligible participants agreed to take part. Forty-three participants were recruited. The main reason for ineligibility was a previous episode of CN. Thirteen participants were withdrawn post-randomisation due to an alternative diagnosis. Nineteen participates achieved remission, six did not. This study found that the intervention, serial MRI was achievable, safe, and acceptable. The qualitative study showed that receiving treatment for CN has physical, socio-economic, and psychological consequences, for the individual and their family which extend beyond the burden of wearing an offloading device. Conclusion: The rates of recruitment, retention, data, and MRI completeness show that a definitive study to evaluate the effectiveness of MRI in disease monitoring in CN is justified and feasible. Healthcare professionals should use a more holistic and person-centred approach to supporting individuals with CN.