Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Charcot neuroosteoarthropathy of the feet can induce severe instability and deformity with subsequent plantar ulceration leading to substantial disability or even amputation. Traditionally, nonoperative treatment is regarded as the primary option of treatment while surgery is restricted to treating complications or failure of nonoperative treatment. Failed nonoperative treatment essentially prolongs treatment period. We retrospectively reviewed 22 patients (26 feet) with midfoot (n = 9) or hindfoot (n = 17) neuropathy who underwent primary surgical reconstruction and reorientation arthrodesis due to manifest instability, nonplantigrade foot position, and deformity with overt (n = 8) or what we judged was impending ulceration (n = 9). The minimum followup was 0.5 years (mean, 2.7 years; range 0.5–7 years). All eight ulcers healed without recurrence of ulceration or manifestation of new ulcers during the followup period. We observed complications leading to further surgery in nine patients: five with perioperative hematoma and four with instability. AOFAS scores rose from a preoperative mean of 39 to 70 points (hindfoot cases) and from 51 points to 84 (midfoot cases). Early surgical reconstruction in high-risk patients can provide timely restoration of a plantigrade and stable foot and improved quality of life of the patient at complication rates comparable to those after secondary surgery following failed nonoperative treatment; however we emphasize we had no control group in this small case series for which we could compare nonoperative treatment.
Level of Evidence: Level IV, therapeutic study (case series). See Guidelines for Authors for a complete description of levels of evidence.
- Armstrong DG, Lavery LA, Harkless LB. Who is at risk for diabetic foot ulceration? Clin Podiatr Med Surg. 1998;15:11–19.
- Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR. The natural history of acute Charcot’s arthropathy in a diabetic foot specialty clinic. J Am Podiatr Med Assoc. 1997;87:272–278.
- Baravarian B, Van Gils CC. Arthrodesis of the Charcot foot and ankle. Clin Podiatr Med Surg. 2004;21:271–289. CrossRef
- Bevilacqua NJ, Rogers LC, Armstrong DG. Diabetic foot surgery: classifying patients to predict complications. Diabetes Metab Res Rev. 2008;24 (Suppl 1):S81–S83. CrossRef
- Burns PR, Wukich DK. Surgical reconstruction of the Charcot rearfoot and ankle. Clin Podiatr Med Surg. 2008;25:95–120. CrossRef
- Chantelau E. The perils of procrastination: effects of early vs. delayed detection and treatment of incipient Charcot fracture. Diabet Med. 2005;22:1707–1712. CrossRef
- Chantelau E, Kimmerle R, Poll LW. Nonoperative treatment of neuro-osteoarthropathy of the foot: do we need new criteria? Clin Podiatr Med Surg. 2007;24:483–503. CrossRef
- Clohisy DR, Thompson Jr RC. Fractures associated with neuropathic arthropathy in adults who have juvenile-onset diabetes. J Bone Joint Surg Am. 1988;70:1192–1200.
- Dhawan V, Spratt KF, Pinzur MS, Baumhauer J, Rudicel S, Saltzman CL. Reliability of AOFAS Diabetic Foot Questionnaire in Charcot arthropathy: stability, internal consistency and measurable difference. Foot Ankle Int. 2005;26:717–731.
- Early JS, Hansen ST. Surgical reconstruction of the diabetic foot: a salvage approach for midfoot collapse. Foot Ankle Int. 1996;17:325–330.
- Eichenholtz SN. Charcot Joints. Springfield, IL: CC Thomas; 1966.
- Garapati R, Weinfeld SB. Complex reconstruction of the diabetic foot and ankle. Am J Surg. 2004;187:81S–86S. CrossRef
- Guyton GP. An analysis of iatrogenic complications from the total contact cast. Foot Ankle Int. 2005;26:903–907.
- Kimmerle R, Chantelau E. Weight-bearing intensity produces Charcot deformity in injured neuropathic feet in diabetes. Exp Clin Endocrinol Diabetes. 2007;115:360–364. CrossRef
- Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–353.
- Marks RM, Parks BG, Schon LC. Midfoot fusion technique for neuropathic feet: biomechanical analysis and rationale. Foot Ankle Int. 1998;19:507–510.
- Myerson MS, Alvarez RG, Lam PW. Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. Foot Ankle Int. 2000;21:643–650.
- Myerson MS, Henderson MR, Saxby T, Short KW. Management of midfoot diabetic neuropathy. Foot Ankle Int. 1994;15:233–241.
- Pakarinen TK, Laine HJ, Honkonen SE, Peltonen J, Oksala H, Lahtela J. Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases. Scand J Surg. 2002;91:195–201.
- Papa J, Myerson M, Girard P. Salvage, with arthrodeses, in intractable diabetic neuropathic arthropathy of the foot and ankle. J Bone Joint Surg Am. 1993;75:1056–1066.
- Pinzur M. Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int. 2004;25:545–549.
- Pinzur MS. Charcot’s foot. Foot Ankle Clin. 2000;5:897–912.
- Pinzur MS. Current concepts review: Charcot arthropathy of the foot and ankle. Foot Ankle Int. 2007;28:952–959. CrossRef
- Pinzur MS. Neutral ring fixation for high-risk nonplantigrade Charcot midfoot deformity. Foot Ankle Int. 2007;28:961–966. CrossRef
- Pinzur M, Kelikian A. Charcot ankle fusion with a retrograde locked intramedullary nail. Foot Ankle Int. 1997;18:699–704.
- Pinzur MS, Sostak J. Surgical stabilization of nonplantigrade Charcot arthropathy of the midfoot. Am J Orthop. 2007;36:361–365.
- Resch S. Corrective surgery in diabetic foot deformity. Diabetes Metab Res Rev. 2004;20(Suppl 19):S34–S36. CrossRef
- Saltzman CL, El-Khoury GY. The hindfoot alignment view. Foot Ankle Int. 1996;17:189–190.
- Saltzman CL, Hagy ML, Zimmerman B, Estin M, Cooper R. How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet? Clin Orthop Relat Res. 2005;435:185–190. CrossRef
- Sammarco GJ, Conti SF. Surgical treatment of neuroarthropathic foot deformity. Foot Ankle Int. 1998;19:102–109.
- Sammarco VJ, Sammarco GJ, Walker EW Jr, Guiao RP. Midtarsal arthrodesis in the treatment of Charcot arthropathy. J Bone Joint Surg Am. 2009;91:80–91. CrossRef
- Sanders LJ, Frykberg RG. Charcot neuropathy of the foot. In: Bowker JH, Pfeifer MA, eds. The Diabetic Foot, 6th ed. St. Louis, MO: Mosby; 2001:439–466.
- Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res. 1998;349:116–131. CrossRef
- Schon LC, Marks RM. The management of neuroarthropathic fracture-dislocations in the diabetic patient. Orthop Clin North Am. 1995;26:375–392.
- Simon SR, Tejwani SG, Wilson DL, Santner TJ, Denniston NL. Arthrodesis as an early alternative to nonoperative management of Charcot arthropathy of the diabetic foot. J Bone Joint Surg Am. 2000;82:939–950.
- Stone NC, Daniels TR. Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy. Can J Surgery. 2000;43:449–455.
- Wagner FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle. 1981;2:64–122.
- Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?
Clinical Orthopaedics and Related Research®
Volume 468, Issue 4 , pp 1002-1011
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Chirurgische Klinik und Poliklinik der Universität Rostock, Abteilung für Unfall- und Wiederherstellungschirurgie, Schillingallee 35, 18055, Rostock, Germany
- 2. Clinica Luganese, Reparto di chirurgia ortopedica, Lugano, Switzerland