Long‐term outcome of persons with diabetic and non‐diabetic neuro‐osteoarthropathy after foot correction using external fixation

Abstract

Aim Diabetic neuro‐osteoarthropathy (Charcot foot) is a serious form of diabetic foot syndrome, often leading to severe deformity of the foot and subsequently to ulcers and osteomyelitis. The aim of this retrospective study was to determine the success rate and long‐term outcomes for a Charcot foot operation using external fixation in 115 individuals who underwent surgery between July 2008 and December 2012. Methods Some 115 consecutive persons, 78 (68%) men and 37 (32%) women, were enrolled in this study. The eligibility criterion for this retrospective study was reconstructive foot surgery using a Hoffmann II external fixator in diabetic and non‐diabetic neuro‐osteoarthropathy. The main examination parameters in the follow‐up were walking ability, amputation and mortality. Average follow‐up was 5.7 (± 3.2) years. Results Ninety‐seven per cent of people were able to walk after the operation with bespoke shoes or an orthosis. At follow‐up, 77% were able to walk and 51% were fully mobile even outside the home. Subsequent amputations were performed in 29 individuals (26%), with 17 (15%) minor and 12 (11%) major amputations. Forty‐seven individuals died before follow‐up, the majority (53%) from cardiovascular events. Average survival time post surgery was 4.5 (± 2.9) years. Conclusion Reconstruction surgery using external fixation is a very useful method for maintaining walking ability in the case of conservatively non‐treatable diabetic and non‐diabetic neuro‐osteoarthropathy. Individuals with severe Charcot foot disease had a low rate of major amputations. Osteomyelitis was the main reason for major amputations.

Long-term follow-up of conservative treatment of Charcot feet

“…In comparison to surgical literature, we could find similar rates in limb salvage (92.9%) compared to studies with similar length of follow-up: 93.7% limbs could be saved according to Fragomen’s series of 16 reconstructed feet[ 40 ]. Another recent study by Spraul et al reported a limb salvage rate of 89% while using the Hoffmann-external Fixator[ 41 ]. In a recent study with a mean of 35 months follow-up that analyzed the outcome of a one-staged reconstruction procedure using the Ilizarov principles, Wirth et al reported successful limb salvage in 93% [ 42 ].…”

Diabetes Update 2021

“…Wichtige neue Daten zu den Ergebnissen nach Behandlung der diabetischen Neuroosteoarthropathie (sog. Charcot-Fuß) kommen von der Arbeitsgruppe des Referenten selbst zusammen mit der chirurgischen Gruppe von Dr. Koller [ 23 ]. Dabei wurden 115 Patienten mit und ohne Diabetes nachuntersucht, bei denen in einem Zentrum konsekutiv zwischen 2008 und 2012 eine rekonstruktive Stellungskorrektur unter Verwendung eines Hoffmann-II-Fixateur externe durchgeführt worden war.…”

Best foot forward

“…Once established, deformity following a Charcot process can require surgical intervention to minimise risk and to restore a functional foot. In this issue, data following external fixation of the reconstructed Charcot foot are presented 6 . The surgical results are impressive with mobility restored postoperatively in almost all participants and maintained in most.…”