Focused Extracorporeal Shockwave Therapy Promotes Healing in Chronic Midfoot Fractures of Charcot Neuro-Osteoarthropathy: A Case Report
Bibliographic record
Abstract
Background: harcot neuro-osteoarthropathy (CNO) causes midfoot fractures, deformity, profound sensory loss and elevated amputation risk, placing a substantial economic burden on the Canadian healthcare system (~$547M/year for diabetic foot complications).Case Presentation: A 44-year-old man with a two-year history of insensate, non-healing 2nd/3rd tarsometatarsal fractures (Eichenholtz Stage 3) underwent five weekly sessions of focused extracorporeal shockwave therapy (Chattanooga Intelect focused shockwave device; 0.3 mJ/mm², 3,000 shocks per session, 4 Hz). The treatment targeted the nonunion site and the sural nerve region (0.12 mJ/mm² for nerve-targeted applications). No analgesia was administered. Sessions 1–2 produced no intra-treatment sensation; Session 3 produced mild tingling, with progressive sensory perception during Sessions 4–5.Outcome: By 2 months there was callus formation, girth decreased from 32 to 26 cm, VAS fell from 8/10 to 2/10, AOFAS improved from 35/90 to 62/90, and protective sensation improved to 4/10 sites. At 6 months the patient was pain-free, cast-free, hiking (5 km/week) with 7/10 protective sensation and AOFAS 85/90; the planned amputation was cancelled. At 12 months the patient continued pain-free, with sustained sensory gains and full return to work. No adverse events occurred.Conclusion: Focused ESWT may produce concurrent bone healing and intra-treatment neurosensory recovery in chronic Charcot nonunion. These dual effects warrant validation in larger, controlled trials and could offer a noninvasive limb-salvage option that reduces the individual and system costs of diabetic foot complications.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".