Surgical treatment of the Charcot foot

Pinzur, Michael S.

doi:10.1002/dmrr.2750

Cited by 23 publications

(10 citation statements)

References 17 publications

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“…Most often, indications are recurrent ulcers, malalignement and soft tissue infection or even osteomyelitis. Procedures that are performed are simple ulcer debridements, open reductions, exostosectomies, arthrodesis with internal or external fixation, or finally amputations [8,14,[20][21][22][23]. Amputations can be divided into minor and major amputations with the latter being procedures above the ankle joint [24].…”

Section: Introductionmentioning

confidence: 99%

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

Gratwohl

Jentzsch

Schöni

et al. 2021

Arch Orthop Trauma Surg

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Background Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially being treated conservatively, and to identify risk factors for reactivation and contralateral development of CN as well as common complications in CN. Methods A total of 184 Charcot feet in 159 patients (median age 60.0 (interquartile range (IQR) 15.5) years, 49 (30.1%) women) were retrospectively analyzed by patient chart review. Rates of limb salvage, reactivation, contralateral development and common complications were recorded. Statistical analysis was performed to identify possible risk factors for limb loss, CN reactivation, contralateral CN development, and ulcer development. Results Major amputation-free survival could be achieved in 92.9% feet after a median follow-up of 5.2 (IQR 4.25, range 2.2–11.25) years. CN recurrence occurred in 13.6%. 32.1% had bilateral CN involvement. Ulcers were present in 72.3%. 88.1% patients were ambulating in orthopaedic footwear without any further aids. Presence of Diabetes mellitus was associated with reactivation of CN, major amputation and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations. Conclusions With consistent conservative treatment of CN with orthopaedic footwear or orthoses, limb preservation can be achieved in 92.9% after a median follow-up of 5.2 years. Patients with diabetic CN are at an increased risk of developing complications and CN reactivation. To prevent ulcers and amputations, every effort should be made to make patients stop smoking. Level of Evidence III, long-term retrospective cohort study

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Section: Introductionmentioning

confidence: 99%

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

Gratwohl

Jentzsch

Schöni

et al. 2021

Arch Orthop Trauma Surg

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“…Esto representa aproximadamente entre el 25 y el 50 % de los pacientes que han desarrollado una neuroartropatía de Charcot 27,29 . A pesar de las series de casos presentadas en este sentido, son necesarios más estudios que intenten arrojar luz sobre la conveniencia de intervenciones quirúrgicas y tipo de ellas en este tipo de pacientes [28][29][30][31] .…”

Section: Discussionunclassified

Reconstrucción quirúrgica de un caso clínico complejo de neuroartropatía de Charcot

Pérez¹,

Cicchinelli²,

Huerta³

et al. 2020

Rev. Esp. Pod.

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La neuroartropatía de Charcot es reconocida como una enfermedad destructiva, progresiva y no infecciosa de origen multifactorial en pacientes con diabetes mellitus como principal causa etiológica. Esta destrucción puede ser a diferentes niveles del pie. El presente artículo presenta un caso clínico de un paciente que sufre una deformidad severa rígida en pie varo secundario a neuroartropatía de Charcot tipo II (según clasificación Sanders & Frykberg) en fase 2 (según clasificación de Eichenholtz) cuya solución de tratamiento propuesto era amputación infracondílea. Se realizó una reconstrucción quirúrgica de la deformidad consistente en alargamiento percutáneo del tendón de Aquiles, tenotomía del tibial posterior, fusión de la columna interna y externa con estabilización mediante placas de bloqueo; también se realizó fusión de la articulación subastragalina y trasposición del extensor común de los dedos y tibial anterior a la base del cuarto metatarsiano. El resultado del caso fue muy bueno y la evolución al año permitió al paciente incorporarse a su actividad diaria. Este artículo pretende mostrar una opción de tratamiento para este tipo de patología con buenos resultados y mostrando una posibilidad de solución a estos pacientes, evitando así la amputación del miembro.

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“…This can initiate a cascade of events that results in an acute Charcot Arthropathy in a neuropathic patient leading to further fractures, dislocations, and unwarranted deformities. 1,2 The problem can be compounded many times by surgical intervention for Ankle and Hindfoot fractures without recognition or due consideration of the neuropathic component and non-adherence to the protocols of surgery for such cases leading to delayed wound and bone healing, infections, non-unions and failure of hardware.…”

Section: Introductionmentioning

confidence: 99%

Results of Ankle and Hind foot arthrodesis in Diabetic Charcot Neuroarthropathy - A retrospective analysis of 44 patients

Rana

Patel

2021

Journal of Clinical Orthopaedics and Trauma

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Background: The role of arthrodesis as a salvage procedure in Diabetic Charcot Neuroarthropathic deformities of the Foot and Ankle is controversial due to relatively high complication rates reported in literature. We intend to present our experience with a retrospective analysis of Ankle and Hindfoot arthrodesis in deformities due to Diabetic Charcot Neuroarthropathy. Study design: A retrospective observational analysis of selected Diabetic Neuropathic Ankle and Hindfoot cases operated at a single centre. Patients and methods: In a study duration extending 7.5 years, 46 operated sites in 44 patients were included in the study. These patients were treated by one of the following procedures: Tibiotalocalcaneal arthrodesis, Pantalar arthrodesis, Ankle arthrodesis, Triple arthrodesis and isolated subtalar arthrodesis. The results were analysed with regard to wound healing and its complications, clinical and radiological progress of union and non-union rates and deformity correction (i.e. whether a plantigrade foot could be achieved and a standard foot wear could be worn post correction). Results: There were four superficial and two deep infections (13%). Symptomatic radiological non-union at one or more joints was seen in 12 cases (26%). Thirty cases united primarily (65%) and showed radiological fusion at an average time of 6.8 months post-surgery. Four cases (8.5%) had asymptomatic radiological partial non union at one or more joints but showed clinical union. Five patients (8.3%) had a low energy spiral fracture of the tibia proximal to the locking plate used for TTC fusion. Complete deformity correction with plantigrade foot was achieved in 32 cases (69.5%). Conclusion: Despite a high complication rate associated with Ankle and Hind foot arthrodesis in Diabetic Charcot Neuroarthropathy, an eventually successful fusion can be achieved in two-third patients.

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Surgical treatment of the Charcot foot

Cited by 23 publications

References 17 publications

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

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

Reconstrucción quirúrgica de un caso clínico complejo de neuroartropatía de Charcot

Results of Ankle and Hind foot arthrodesis in Diabetic Charcot Neuroarthropathy - A retrospective analysis of 44 patients

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