Managing Acute Fore- and Midfoot Fractures in Patients with Diabetes

CORR Insights®: No Difference in Risk of Amputation or Frequency of Surgical Interventions Between Patients With Diabetic and Nondiabetic Charcot Arthropathy

“…Those authors suggested that although midfoot CN may be more common, it is more amenable to nonsurgical treatment such as bracing and orthotics than CN of the ankle or hindfoot [8]. This echoes my own experience; I’ve found that midfoot CN can be managed with initial nonsurgical treatment followed by exostectomy, if appropriate, for bony prominences associated with neuropathic ulcers (with or without tendon releases), while ankle and hindfoot CN tends to be more unstable despite bracing, especially when the talus is destroyed [5]. Likewise, 13 of 15 fusion surgeries in the study by Bariteau et al [2] were for the ankle and hindfoot while only two patients underwent midfoot fusion surgeries.…”

“…Charcot neuroarthropathy (CN) is characterized by chronic and progressive destruction of bone and joints that can lead to deformities, ulcerations, and even amputation [2, 3, 5, 7-10]. It is most commonly associated with peripheral neuropathy from diabetes mellitus [2, 3, 5, 7-10].…”

“…CORR Insights®: No Difference in Risk of Amputation or Frequency of Surgical Interventions Between Patients With Diabetic and Nondiabetic Charcot Arthropathy Choon Chiet Hong MBBS, FRCSEd (Orth) 1 Where Are We Now? C harcot neuroarthropathy (CN) is characterized by chronic and progressive destruction of bone and joints that can lead to deformities, ulcerations, and even amputation [2,3,5,[7][8][9][10]. It is most commonly associated with peripheral neuropathy from diabetes mellitus [2,3,5,[7][8][9][10].…”

“…C harcot neuroarthropathy (CN) is characterized by chronic and progressive destruction of bone and joints that can lead to deformities, ulcerations, and even amputation [2,3,5,[7][8][9][10]. It is most commonly associated with peripheral neuropathy from diabetes mellitus [2,3,5,[7][8][9][10]. This is not surprising, because the prevalence of diabetes globally was estimated to be half a billion in 2021, a number expected to rise to 643 million by 2030 and to 783 million by 2045 [6].…”

“…CN can affect other joints but commonly affects the foot, with a prevalence ranging from 0.08% to 13% among patients with diabetes [4]. Similarly, patients with diabetes and CN are at much greater risk of amputation and incurred higher treatment costs than did patients with diabetes without CN [1,4,5,7,8]. As it appears from those sources, surgeons are reasonably well informed about the diagnosis, risk of clinical progression, treatment options, and outcomes of treatment for diabetic CN of the foot.…”