SLR - September 2011 - Uchenna Chukwurah
Reference: Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet? Clin Orthop Rel Research. Vol 468, Number 4, 2010.
Scientific Literature Review
Reviewed by: Uchenna Chukwurah, DPM
Residency Program: St. John Hospital and Medical Center, Detroit, MI
Podiatric Relevance:
This retrospective review provides relevant data to respond to the dilemma of early surgical intervention in patients with advanced mechanical instability of the foot and/or ankle secondary to Charcot neuroarthropathy.
Methods:
This study involves a retrospective review of 26 limbs in 22 patients treated with primary surgical foot reconstruction from January 2001 to December 2007. The inclusion criteria included: (1) Charcot neuroarthropathy in the midfoot and/or hindfoot; (2) instability or joint subluxation; (3) pre-ulcerative or ulcerative lesions. Twenty of the 22 patients had diabetes with 85% requiring insulin control. Two of the 22 patients were treated non-surgically with immobilization in a bivalved custom-fit orthosis or an orthotic walker for less than 6 weeks. The remaining 20 patients were treated with primary surgical reconstruction. All preoperative planning was done with weight-bearing radiographs of both feet and ankles. Surgical treatment entailed maintenance of the talonavicular joint in patients with an isolated midfoot neuroarthropathy and a triple arthrodesis if hindfoot involvement was detected. Achilles tendon lengthening was performed in all cases of equinus. Postoperative management included non-weightbearing in a total contact cast.
Results:
Minimum follow-up was 0.5 years. Complications leading to further surgery were noted in nine patients: five with hematoma and four with instability. AOFAS scores improved from 39 to 70 point (hindfoot) and 51 to 84 (midfoot). All ulcers healed without recurrence. A stable, plantigrade foot was obtained in all cases.
Conclusions:
Early primary reconstruction in patients with Charcot arthropathy can restore a plantigrade and stable foot and potentially improve the quality of life in carefully selected patients.