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

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Charcot Joint.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Charcot Joint (Neurogenic Arthropathy)

Refers to a weight-bearing joint’s gradual degeneration, which is characterised by bone resorption, bone disintegration, and ultimately deformity brought on by neuropathy-related feeling loss. The underlying neuropathy is addressed as part of the treatment.

1. Diagnostic Studies for Charcot Joint in workers compensation patients

   Diagnostic Studies for Charcot Joint in workers compensation patients for X-Rays is recommended for diagnosing Charcot Joints.

    

2. MRIs

   MRIs are recommended to improve staging of Charcot joints.

Medications for Charcot Joint

Due to the likelihood that the joint may become denervated, acetaminophen and/or non-steroidal anti-inflammatory medicines (NSAIDs) are frequently not necessary for pain relief, but they are advised if necessary.

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or its analogue paracetamol) may be a viable substitute, candidates for NSAIDs, despite the majority of research indicating that acetaminophen is somewhat less efficient.

There is proof that NSAIDs are just as useful for treating pain as pain as opioids (including tramadol) and less damaging.

1. NSAIDs for Treatment of Acute, Subacute, Chronic, or Postoperative Charcot Joint Pain

   NSAIDs for Treatment of Acute, Subacute, Chronic, or Postoperative Charcot Joint Pain are recommended for the management of postoperative, chronic, or subacute Charcot joint pain.

   Frequency/Duration: Many patients could find it reasonable to use as needed.

   Indications for Discontinuation:resolution of ankle/foot discomfort, absence effectiveness, or the emergence of unfavourable effects that are necessary discontinuance.

    

2. NSAIDs for Patients at High-Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High-Risk of Gastrointestinal Bleeding is recommended patients who are at a high risk of gastrointestinal bleeding should take misoprostol, sucralfate, histamine type 2 receptor blockers, and proton pump inhibitors concurrently.

   Indications:For patients who additionally have a high-risk factor profile, the use of NSAIDs and cytoprotective drugs should be taken into account, especially if longer-term treatment is being discussed. At-risk Patients having a background of previous gastrointestinal bleeding, older people, people with diabetes, and smokers.

   Frequency/Dose/Duration:H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. There isn’t typically thought to be anything there, varying levels of effectiveness for stopping gastrointestinal bleeding. Signals of Discontinuation Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended Acetaminophen or aspirin as the first-line therapy appears to be the safest considering cardiovascular effects. If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.

   To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving 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.

    

4. Acetaminophen for Treatment of Acute, Subacute, or Chronic Charcot Joint Pain

   Acetaminophen for Treatment of Acute, Subacute, or Chronic Charcot Joint Pain are recommended for the treatment of acute, subacute, or chronic Charcot joint pain, especially in people who have medical conditions that make NSAIDs contraindicated.

   Indications: Acute, subacute, chronic, and postoperative joint pain in all individuals.

   Dose/Frequency:As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.

   Indications for Discontinuation:pain, side effects, or intolerance are gone.

Rehabilitation for Charcot Joint

If supervised formal therapy is necessary as a result of a work-related injury, it should be centred on restoring the functional ability needed for the patient to engage in daily activities and return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.

To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

To facilitate functional gains, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.

1. Gait Training

   Gait Training is recommended in order to treat Charcot joints.

    

2. Splints, Walking Braces, Orthoses and Casts in Select Patients

   Splints, Walking Braces, Orthoses and Casts in Select Patients is recommended in order to treat Charcot joints.

Surgery for Charcot Joint

1. Surgical Procedures Including Ostectomy May Be Performed to Address Deformities That Place the Foot

   Surgical Procedures Including Ostectomy May Be Performed to Address Deformities That Place the Foot at Risk of Ulceration is recommended to treat foot abnormalities that increase the risk of an ulcer.to treat foot abnormalities that increase the risk of an ulcer.

    

2. Open Reduction Internal Fixation of Fractures

   Open Reduction Internal Fixation of Fractures is recommended fractures with open reduction and internal fixing

    

3. Fusion of Charcot Joints in Select Patients

   Fusion of Charcot Joints in Select Patients is recommended charcot Joints fusing together.

    

4. Arthroplasty (Total Joint Replacement) for Charcot Joints

   Arthroplasty (Total Joint Replacement) for Charcot Joints is not recommended for Charcot Joints.

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

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.