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Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?

Abstract

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.

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Fig. 1A–H

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Acknowledgments

We thank Thomas Wodetzki, Rostock, for his support with the photographic material.

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Correspondence to Thomas Mittlmeier MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Chirurgische Klinik und Poliklinik der Universität Rostock, Germany.

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Mittlmeier, T., Klaue, K., Haar, P. et al. Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?. Clin Orthop Relat Res 468, 1002–1011 (2010). https://doi.org/10.1007/s11999-009-0972-x

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  • DOI: https://doi.org/10.1007/s11999-009-0972-x

Keywords

  • Nonoperative Treatment
  • AOFAS Score
  • Total Contact Casting
  • Osseous Healing
  • Charcot Arthropathy