SLR - December 2012 - Christie

Surgical Stabilization of Nonplantigrade Charcot Arthropathy of the Midfoot

Reference: Pinzur, M., and Sostak, J. (2007). Surgical Stabilization of Nonplantigrade Charcot Arthropathy of the Midfoot. The American Journal of Orthopedics, 36(7):361-365

Scientific Literature Review

Reviewed by: Nyssa Christie, DPM
Residency Program: University Hospitals Richmond Medical Center

Podiatric Relevance:
Dealing with Charcot neuroarthropathy is a delicate and complicated matter that requires an adequate balance of conservative and sometimes surgical correction. This study develops an algorithm with which to determine those who are surgical candidates and those who are not. 

Fifty-one adults (28 male, 23 female) with Charcot arthropathy of the midfoot underwent surgical correction of their deformity. All feet that were surgically corrected were nonplantigrade and were at high risk for ulceration. Every foot was classified as end stage Eichenholtz II or Eichenholtz III.

One of three surgical procedures were performed based on the surgeon's clinical evaluation of the patient's condition. In 18 patients it was decided that a partial tarsectomy and fixation with crossed 7.0 mm screws was appropriate. In 22 patients an additional gastrocnemius-soleus lengthening was performed and midfoot fixation following tarsectomy was with a plate and screws. The remaining 11 patients were higher risk (poor bone stock, ulceration or infection) and an external fixator was elected for fixation.

At a minimum of one-year follow-up, 44 of the 51 patients had favorable outcomes and were infection- and ulcer-free ambulating with available custom foot orthoses. The talar-first metatarsal angle was also shown to decrease with surgery to 6.4 degrees (mean) compared to 27.6 degrees (mean) preoperatively. Of the remaining seven patients, one patient died to an unrelated cause, three patients underwent amputation due to infection and three additional patients had a good result but wanted to wear a Charcot restraint orthosis.

Reconstructive surgery should be considered for diabetic patients with Charcot arthropathy who have a non-plantargrade or nonlinear lateral talar-first metatarsal axis in order to greatly improve their quality of life by allowing them to ambulate ulcer-free in custom foot orthosis. In this study desired results were found in 86 percent (44 of 51) of these high risk patients.

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