Bone mineral density during total contact cast immobilization for a patient with neuropathic (Charcot) arthropathy

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 DNI, 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/cm(2) to 0.20 g/cm(2)) and increased for the uninvolved foot (from 0.27 g/cm(2) to 0.31 g/cm(2)) 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.