{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:22:58Z","timestamp":1791249778220,"version":"4.1.0"},"reference-count":27,"publisher":"American Diabetes Association","issue":"2","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"name":"Sweden\u2019s Southern Health Care Region"},{"DOI":"10.13039\/100016409","name":"Gyllenstiernska Krapperup Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100016409","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Charcot foot (CF) requires prolonged offloading of the affected foot to decrease the risk of deformity. The earliest phase in active CF (stage 0) is characterized by inflammatory signs without established fractures or skeletal deformity. We investigated whether offloading in stage 0 influences duration of total contact casting (TCC), risk of recurrence, and future need for surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>All patients treated for active CF at Sk\u00e5ne University Hospital (Lund, Sweden) between 2006 and 2019 were screened for participation in a retrospective cohort study. CF events of included patients were classified as stage 0 or 1 according to X-ray and MRI reports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 183 individuals (median age 61 [interquartile range (IQR) 52\u201368] years, 37% type 1 diabetes, 62% men) were followed for a median of 7.0 (IQR 3.9\u201311) years. In 198 analyzed CF events, 74 were treated with offloading in stage 0 and 124 in stage 1. Individuals offloading in stage 0 had significantly shorter TCC duration (median 75 [IQR 51\u2013136] vs. 111.5 [72\u2013158] days; P = 0.001). The difference was sustained when including only MRI-confirmed CF. The risk of developing new ipsilateral CF events &amp;gt;1 year after introduced definitive footwear was lower in those treated with offloading in stage 0 (2.7% vs. 9.7%; P &amp;lt; 0.05). No individual treated with offloading in stage 0 underwent reconstructive surgery, compared with 11 (8.9%) treated with offloading in stage 1 (P &amp;lt; 0.01). Amputation rates were similar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Offloading in stage 0 CF was associated with shorter TCC treatment, lower risk of a new CF event, and diminished need for reconstructive surgery. Future amputation risk was not affected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc23-1063","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T12:24:31Z","timestamp":1701347071000},"page":"252-258","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":6,"title":["Charcot Foot Offloading in Stage 0 Is Associated With Shorter Total Contact Cast Treatment and Lower Risk of Recurrence and Reconstructive Surgery: A Pilot Study"],"prefix":"10.2337","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0797-5092","authenticated-orcid":false,"given":"Johan","family":"Schoug","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund, Sweden"},{"name":"Institution for Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Katzman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund, Sweden"},{"name":"Institution for Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7967-2576","authenticated-orcid":false,"given":"Katarina","family":"Fagher","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund, Sweden"},{"name":"Institution for Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1522-3920","authenticated-orcid":false,"given":"Magnus","family":"L\u00f6ndahl","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital, Lund, Sweden"},{"name":"Institution for Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"2024011919582629900_B1","first-page":"161","article-title":"Sur quelques arthropathies qui paraissent d\u00e9pendre d\u2019une l\u00e9sion du cerveau ou de la moelle \u00e9pini\u00e8re","volume":"1","author":"Charcot","year":"1868","journal-title":"Archives de Physiologie Normale et Pathologique"},{"key":"2024011919582629900_B2","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.2337\/dc11-0844","article-title":"The Charcot foot in diabetes","volume":"34","author":"Rogers","year":"2011","journal-title":"Diabetes Care"},{"key":"2024011919582629900_B3","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.2337\/dc21-2508","article-title":"The Charcot foot reflects a response to injury that is critically distorted by preexisting nerve damage: an imperfect storm","volume":"45","author":"Jeffcoate","year":"2022","journal-title":"Diabetes Care"},{"key":"2024011919582629900_B4","doi-asserted-by":"crossref","first-page":"e3646","DOI":"10.1002\/dmrr.3646","article-title":"Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023)","volume":"23","author":"Wukich","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"key":"2024011919582629900_B5","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s00125-011-2354-7","article-title":"Audit of acute Charcot\u2019s disease in the UK: the CDUK study","volume":"55","author":"Game","year":"2012","journal-title":"Diabetologia"},{"key":"2024011919582629900_B6","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13047-021-00477-5","article-title":"Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study","volume":"14","author":"Griffiths","year":"2021","journal-title":"J Foot Ankle Res"},{"key":"2024011919582629900_B7","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1177\/145749690209100212","article-title":"Charcot arthropathy of the diabetic foot. 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