Midfoot Charcot Reconstruction

Siddiqui, Noman A.; LaPorta, Guido A.

doi:10.1016/j.cpm.2018.07.003

Cited by 17 publications

(10 citation statements)

References 18 publications

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“…The Eichenholtz (Table 1) [7], Schon (Table 2) [8], Brosdky (Table 3) [9] classifications are currently used, but those of Sanders and Frykberg (Table 4) [10], Sella and Barrette [11] are also mentioned. The tarsometatarsal joint and midtarsal joints are most commonly involved [29], the talus often collapses due to avascular necrosis or neuropathic fracture resulting in prominent malleoli [12], varus hindfoot, valgus forefoot and the classically described rocker-bottom deformity accompanied by dorsiflexion of the midfoot onto the hindfoot ("bayonet" effect) [13]. Lateral column involvement (calcaneocuboid luxation) is rarer, but associated with a worse prognosis than medial column involvement (peritalar dislocation of the navicular-cuneiform joint) [14][15][16] and as the apex of deformity moves more proximally, the deforming forces increase, stressing the affected area and any fixation construct applied [17].…”

Section: Classification and Deformitiesmentioning

confidence: 99%

“…Acute alignment can be achieved through wedge resection (guided by transversal K-wires) [14,17] and fixation, but gradual correction is preferred because it allows maintaining foot length and bone mass and reduces the risk of neurovascular compromise [13]. In case of major deformity or osteomyelitis, double-stage reconstruction is advisable, and the remission of inflammation is obligatory (except for ankle interventions) [15].…”

Section: Alignment and Complementary Interventionsmentioning

confidence: 99%

“…Bone morphogenetic proteins in the shape of demineralized bone matrix, bone marrow aspirates or platelet-rich plasma further enhance the environment to assure fusion and healing [13,34,35].…”

Section: Resections and Bone Graftsmentioning

confidence: 99%

“…It allows direct wound visualization, offloading, and assistance in major flap closure procedures while protecting soft tissue and neurovascular structures. It may be employed independently (hexapods or distraction osteogenesis rings in double stage procedures to distract the bones gradually using computer programs based on daily radiographies) [13,31,37] or to protect internal constructs until radiographic bony consolidation occurs (Ilizarov, bar-clamp fixators) [18,33], together with a kickstand apparatus for leg elevation and surgical offloading. The use of smooth wires versus half pins apparently has fewer complications in the diabetic population [38].…”

confidence: 99%

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Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

Ion

2018

Romanian Journal of Orthopaedic Surgery and Traumatology

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Introduction and purpose:Charcot neuroarthropathy defines a cluster of progressive lesions affecting the joints and bones, as well as the soft tissues of the foot in the context of diabetes, a pivotal role being attributed to peripheral neuropathy. Loss of sensation and proprioception, subsequent repeated trauma, muscle and autonomic nervous system impairment contribute to the alteration of the foot’s architecture and distribution of pressure, ultimately triggering ulceration and gangrene. The urge to avoid amputation has fueled the development of conservative and reconstructive techniques capable of delaying, if not preventing such negative outcomes. The purpose of this review was to present the most frequently used reconstruction procedures and the challenges arising in adapting them to particular foot morphologies and lesion stages. Methods:Literature search was conducted using PubMed, resulting in around 90 articles, multicenter studies and reviews, 26 of which were considered most relevant in providing the guidelines for orthopedic reconstruction and postoperative care in Charcot foot patients with diabetic neuropathy prevailing over arteriopathy. Results:The tarsometatarsal and metatarsophalangeal joints are most frequently affected. Closed reduction, arthrodesis, and tendon lengthening are key features of an efficient correction, alternatively accompanied by resections and tenotomies. Ulceration and callus debridement may also be necessary, while prolonged casting and immobilization remain obligatory. Conclusions:Most authors agree that stabilizing the deformities, optimizing the pressure on the soft tissues, and promoting the healing of potential lesions are the main purposes of the interventions. Prompt recognition and correction of Charcot foot deformities improve life quality and minimize the prospects of amputation.

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Section: Classification and Deformitiesmentioning

confidence: 99%

Section: Alignment and Complementary Interventionsmentioning

confidence: 99%

Section: Resections and Bone Graftsmentioning

confidence: 99%

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Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

Ion

2018

Romanian Journal of Orthopaedic Surgery and Traumatology

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“…In Charcot neuroarthropathy, the goal of surgical reconstruction is to establish a stable, plantigrade foot enabling patients to be community ambulators. 1 in segmental bone loss due to either bone resection to acutely reduce angular deformity or removal of nonviable avascular bone. 2 A viable treatment for Charcot neuroarthropathy deformity is an arthrodesis of the tibiotalocalcaneal complex.…”

Section: Introductionmentioning

confidence: 99%

Increased Arthrodesis Rates in Charcot Neuroarthropathy Utilizing Distal Tibial Distraction Osteogenesis Principles

Siddiqui

Millonig

Mayer

et al. 2022

Foot & Ankle Specialist

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Charcot neuroarthropathy of the hindfoot and ankle poses substantial challenges due to deformity, segmental bone loss, chronic infection, and difficulty with bracing. Hindfoot or ankle arthrodesis is often employed at high rates of complications and nonunion. This study reports 15 consecutive patients with Charcot neuroarthropathy who underwent tibiotalocalcaneal or tibiocalcaneal fusion with simultaneous distal tibial distraction osteogenesis with a mean follow-up period of 20.2 ± 5.66 months. Arthrodesis rate was 93.3% (14 patients) with mean time to fusion of 4.75 ± 3.4 months. One hypertrophic nonunion occurred at the arthrodesis site. Complete consolidation of 4 cortices was achieved at the distraction site in 93.3% of patients (14 patients) with a mean duration to consolidation of 9.8 ± 3.3 months. One patient experienced hypertrophic nonunion at the regeneration site. The authors report a technique to enhance arthrodesis rates in Charcot neuroarthropathy by combining distal tibial distraction osteogenesis with simultaneous tibiotalocalcaneal or tibiocalcaneal arthrodesis for hindfoot fusion and salvage. Distraction osteogenesis supports enhanced vascularity to the arthrodesis site. Level of Clinical Evidence: Level 4

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Case #30: Management of Charcot Midfoot Deformity with Trans-cuneonaviculocuboid Wedge

Visser

2022

Challenges in Foot and Ankle Reconstructive Surgery

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Midfoot Charcot Reconstruction

Cited by 17 publications

References 18 publications

Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

Increased Arthrodesis Rates in Charcot Neuroarthropathy Utilizing Distal Tibial Distraction Osteogenesis Principles

Case #30: Management of Charcot Midfoot Deformity with Trans-cuneonaviculocuboid Wedge

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