Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle.

Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?

“…Early surgical intervention in high-risk patients may allow shorter periods of treatment at lower costs with an improved quality of life. We believe surgical reconstruction in Charcot feet should not be limited to a salvage procedure and an alternative to amputation in failed nonoperative care [20,30]. Amputation may be the more expensive option compared with reorientation arthrodesis [4].…”

“…Limbs with open ulceration at the initial presentation and limbs with recurrent ulceration have decreased limb survival rate compared to feet without ulcers, adding to an annual limb amputation rate of approximately 1% to 5% [21,23,29]. The goals of treatment should not be merely to save the limb [10,[19][20][21][22]: Pinzur proposed the goal include a long-term infection-and ulcer-free plantigrade and stable foot that allows the patient to walk with commercially available depth-inlay therapeutic footwear [21].…”

“…Traditionally, the Eichenholtz stage relying on clinical and standard radiographic examination [11] and the site of the disease [32] provide the key determinants for selecting the primary therapeutic strategy [7,21]. Nonoperative immobilization techniques using specific orthoses or total contact casts still represent the mainstay for the initial phases of Charcot neuroarthropathy, while surgery is reserved for patients with infection, recurrent ulceration, and substantial deformity or joint instability not manageable by casting or orthotic devices [3,20,29]. As most Charcot feet manifest in the midfoot, the majority of studies describe lesions in the midfoot area [8,10,16,18,33,34,36].…”

“…As such, more than 40% of the patients with midfoot disease who had been managed primarily nonoperatively may require surgery in the further clinical course [21,23]. While formerly corrective arthrodesis of nonplantigrade neuroarthropathic feet has been regarded as a salvage procedure and an alternative to amputation [20], more recent reports relying on biomechanically sound stabilization techniques have demonstrated maintenance of walking independence using commercially available therapeutic footwear and an infection-free foot [26] despite a high complication rate varying from 10% to more than 30% [3,19]. One study of 14 patients with Stage I Charcot arthropathy at the midfoot level reported successful healing of the primary corrective arthrodesis without immediate or long-term complications or any recurrent ulceration during a mean followup period of 41 months [35].…”

The effects of blood glucose control upon fracture healing in the BB Wistar rat with diabetes mellitus

“…One comparative study [30] demonstrated a significant delay of fracture healing (uniting at an average of 187% of time in non-neuropathic DM patients compared to patients without DM). Three retrospective studies have noted increased incidence of delayed union, non-union, and pseudarthrosis following elective arthrodesis in neuropathic DM patients [26,29,30].…”