After taking the load off a Charcot foot, practitioners can try bisphosphonates to treat the condition, Dr. Rogers said.
The two agents that have been studied for Charcot foot are pamidronate (Aredia) and alendronate (Fosamax). Pamidromate can be given in a single 90-mg intravenous dose. (You may have to answer questions from the pharmacy because of dosing requirements for patients with renal insufficiency, but there are no dosing requirements if you are giving the dose only once, because the half-life doesn’t really matter in that case, Dr. Rogers said.) Alendronate was given in oral doses of 70 mg weekly in one study in which it was compared with pamidronate for Charcot foot, and it took longer to achieve normal foot temperature.
Another drug studied for Charcot foot is intranasal calcitonin (Miacalcin), which "might make more pathological sense," said Dr. Rogers. It is sprayed once per day in alternating nostrils. It should be given in combination with vitamin D and calcium.
How do you determine whether any of these therapies is working? By using a contact thermometer, you can compare the Charcot foot to the non-Charcot foot. A difference between the two that is greater than 4° F (2° C) is considered significant for inflammation. "Make sure this gets back to [within a] 4° difference before you put them back in their normal footwear," said Dr. Rogers.
Thermal imaging is helpful with patient compliance because it helps the patient see the difference, he said.
After getting the patient into an inactive state, make sure the foot stays protected so it doesn’t develop an ulcer, Dr. Rogers said in conclusion.
Dr. Rogers said he had no conflicts of interest to disclose.