New York State Medical Treatment Guidelines for Charcot Joint in workers compensation patients

The guidelines for Charcot Joint have been formulated by the New York State Workers Compensation Board to aid physicians, podiatrists, and other healthcare professionals in delivering suitable treatment.

These guidelines from the Workers Compensation Board are designed to be a valuable resource for healthcare professionals, helping them make informed decisions about the right level of care for patients with ankle and foot disorders.

It’s crucial to emphasize that these guidelines are not a replacement for clinical judgment or professional experience. The ultimate decision regarding care should be a collaborative one between the patient and their healthcare provider.


Charcot Joint (Neurogenic Arthropathy)

Charcot Joint refers to the gradual degeneration of a weight-bearing joint, marked by bone resorption, disintegration, and eventual deformity resulting from neuropathy-related loss of sensation. Treatment typically involves addressing the underlying neuropathy.

For workers’ compensation patients with Charcot Joint, it is recommended to undergo Diagnostic Studies, specifically X-Rays, for an accurate diagnosis.

Additionally, MRIs are recommended to enhance the staging of Charcot joints, providing a more comprehensive understanding of the condition.


Medications for Charcot Joint

Given the potential denervation of the joint, acetaminophen and/or non-steroidal anti-inflammatory medicines (NSAIDs) may not always be necessary for pain relief in Charcot Joint cases, but they are recommended if needed.

Ibuprofen, naproxen, or other earlier-generation NSAIDs are suggested as the first-line treatments for most patients. Acetaminophen (or its analogue paracetamol) may be considered as an alternative for patients not suitable for NSAIDs, although research suggests it may be somewhat less effective.

Evidence indicates that NSAIDs are as effective in treating pain as opioids (including tramadol) and are less harmful.

For the management of acute, subacute, chronic, or postoperative Charcot Joint pain, NSAIDs are recommended. The frequency and duration of use can be tailored to the patient’s needs.

In cases where patients are at a high risk of gastrointestinal bleeding, concurrent use of misoprostol, sucralfate, histamine type 2 receptor blockers, and proton pump inhibitors is recommended. This is particularly important for those with a high-risk profile, including a history of gastrointestinal bleeding, older individuals, people with diabetes, and smokers. The use of NSAIDs and cytoprotective drugs should be carefully considered, especially for longer-term treatment.

The signals for discontinuation include the resolution of ankle/foot discomfort, the lack of effectiveness, or the emergence of adverse effects that necessitate discontinuation. Dosage recommendations for H2 blockers, misoprostol, sucralfate, and proton pump inhibitors should be followed, and discontinuation should be considered in the presence of intolerance, the emergence of negative effects, or the cessation of NSAIDs.

For patients at risk of cardiovascular adverse effects, the use of NSAIDs is recommended. Acetaminophen or aspirin is considered the first-line therapy due to their perceived safety regarding cardiovascular effects. If necessary, non-selective NSAIDs are suggested over COX-2-specific medications.

To minimize the risk of an NSAID counteracting the protective effects of low-dose aspirin in individuals using it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

Acetaminophen is recommended for the treatment of acute, subacute, or chronic Charcot Joint pain, particularly in individuals with medical conditions that make NSAIDs contraindicated.

The indications for discontinuation of Acetaminophen include the absence of pain, resolution of side effects, or intolerance. It is advised to follow the manufacturer’s recommendations for dosage and frequency, with evidence of liver toxicity observed over four gm/day.


Rehabilitation for Charcot Joint

If supervised formal therapy becomes necessary due to a work-related injury, the focus should be on restoring the functional abilities required for the patient to engage in daily activities and return to work. The ultimate goal is to bring the injured worker back to their pre-injury status to the extent that is practical.

Active therapy involves the patient putting in internal effort to complete specific activities or tasks. In contrast, passive therapy relies on modalities administered by a therapist without the patient actively contributing effort.

While passive therapies are often used to expedite an active therapy program and achieve concurrent objective functional gains, the emphasis should be on prioritizing active initiatives over passive interventions.

To maintain the achieved improvement levels, patients are encouraged to continue both active and passive therapies at home as an extension of the therapeutic process.

In the rehabilitation strategy, assistive devices may be utilized as an additional measure to facilitate functional gains.

Gait Training is recommended for treating Charcot joints, and the use of Splints, Walking Braces, Orthoses, and Casts in select patients is also recommended for treating Charcot joints.


Surgery for Charcot Joint

To address Charcot joints, various surgical options may be considered:

  1. Surgery for Charcot Joint: Surgical procedures, including ostectomy, may be performed to address deformities that place the foot at risk of ulceration. This is recommended for treating foot abnormalities that increase the risk of an ulcer.
  2. Open Reduction Internal Fixation of Fractures: This procedure is recommended for fractures that require open reduction and internal fixation.
  3. Fusion of Charcot Joints in Select Patients: Fusion of Charcot joints is recommended in select patients, particularly when the joints need to be fused together.
  4. Arthroplasty (Total Joint Replacement) for Charcot Joints: Total joint replacement, or arthroplasty, is not recommended for Charcot joints.

These surgical interventions are tailored to the specific needs and conditions of the patient, aiming to address deformities, fractures, or joint fusion associated with Charcot joints. The choice of surgery depends on the individual case and the underlying factors contributing to the condition.


What our office can do if you have Charcot Joint due to workers compensation injuries.

We possess the expertise to assist you with your workers’ compensation injuries. We empathize with the challenges you are facing and are committed to addressing your medical needs while adhering to the guidelines set by the New York State Workers Compensation Board.

Recognizing the significance of your workers’ compensation cases, we are here to guide you through the complexities of dealing with the insurance company and your employer.

We understand that this is a stressful time for you and your family. If you wish to schedule an appointment, please reach out to us. We are dedicated to making the process as easy for you as possible and will do everything in our power to support you.

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