Charcot foot reconstruction outcomes: A systematic review

Abstract

Background: Charcot neuroarthropathy is a complex condition characterised by progressive deformity, limited treatment options and a high amputation rate. Surgical reconstruction of Charcot foot has been proposed as a method to preserve the foot. However, limited information exists on the different methods of reconstruction available, their outcomes and complications. Methods: We systematically analysed published data from Jan 1993 to Dec 2018 to assess methods of fixation and associated outcomes for the surgical reconstruction in Charcot neuroarthropathy. Statistical analyses were undertaken to determine the amputation rates, return to ambulation and complications associated with these techniques. Results: A total of 1116 feet (1089 patients) were reported to have undergone reconstruction with significant heterogeneity in patient selection. Of these, 726 (65%) were reported to undergo internal fixation, 346 feet (31%) external fixation and 44 (4%) undergoing simultaneous internal and external fixation. No single technique demonstrated a significant benefit over the other. Overall, the bone fusion rate was 86.1%. Complications directly attributable to the technique employed were noted in 36% of individuals. The reported post-reconstruction amputation rate was only 5.5% with 91% apparently returning to ambulation. Conclusions: Although no preferential method of fixation was identified, we find that the current options for surgical reconstruction could offer limb salvage with a low amputation risk in a highly selected population. However, the lack of controlled studies, inconsistent reporting of outcomes and heterogeneity of patient selection mean that the quality of evidence is low.

Surgical strategies for prevention of amputation of the diabetic foot

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Charcot hindfoot deformity reconstruction using a hindfoot nail- surgical technique

“…Published literature revealed similar outcomes with internal and external fixations options for such procedures and confirmed the vast majority of patients achieved ambulatory status following reconstruction. 3 In comparison to the other forms of internal fixation, an intramedullary (IM) hindfoot nail is considered to provide better stability and offer superior resistance to the multiplanar forces across the ankle joint exerted by the long leaver arm of the foot. An IM nail also acts as a load sharing device and thereby can potentially allow earlier return to weight-bearing.…”

Superconstructs in reconstruction surgery of Charcot foot Brodsky 1: A case report

“…Charcot neuroarthropathy is a debilitating illness. Charcot foot and ankle deformity can have a significant damaging effect on anyone's lifestyle, increased morbidity, and early decreased of quality of life [5] , [10] . The early recognition of a diabetic, or Charcot arthropathy is essential for a satisfactory outcome following treatment [3] , [14] .…”