Advertisement

A Systematic Review of Current Surgical Interventions for Charcot Neuroarthropathy of the Midfoot

Published:August 01, 2017DOI:https://doi.org/10.1053/j.jfas.2017.06.011

      Abstract

      Charcot neuroarthropathy of the foot, or Charcot foot, is a pathologic entity of the foot, associated with diabetes mellitus. Owing to the increase of diabetes mellitus in developed nations worldwide, the prevalence of Charcot foot has been increasing. The initial treatment of Charcot foot is often conservative, with methods including bracing, casting, and the use of customized orthopedic shoes. However, many cases of Charcot foot eventually require surgery, because the consequent destabilization of the foot associated with bone, joint, and nerve injury due to the pathology eventually leave patients unable to walk independently. The present systematic review analyzed the published data regarding surgical interventions for midfoot Charcot deformities and estimated the rates of common complications occurring with the surgical modalities studied. The main outcomes of interest analyzed in the present study were postoperative amputation and bony fusion. The included cohort of patients with Charcot foot was very heterogeneous in terms of the demographic and comorbid characteristics. However, even with this heterogeneity, the present study should provide useful information to surgeons in terms of the outcomes after some of the common surgical procedures for midfoot Charcot.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Caravaggi C.M.
        • Sganzaroli A.B.
        • Galenda P.
        • Balaudo M.
        • Gherardi P.
        • Simonetti D.
        • Ferraresi R.
        • Farnetti A.
        • Morandt A.
        Long-term follow-up of tibiocalcaneal arthrodesis in diabetic patients with early chronic Charcot osteoarthropathy.
        J Foot Ankle Surg. 2012; 51: 408-411
        • Gessmann J.
        • Citak M.
        • Fehmer T.
        • Schildhauer T.A.
        • Seybold D.
        Ilizarov external frame technique for Pirogoff amputations with ankle disarticulation and tibiocalcaneal fusion.
        Foot Ankle Int. 2013; 34: 856-864
        • Gil J.
        • Schiff A.P.
        • Pinzur M.S.
        Cost comparison: limb salvage versus amputation in diabetic patients with Charcot foot.
        Foot Ankle Int. 2013; 34: 1097-1099
        • Grant W.P.
        • Garcia-Lavin S.E.
        • Sabo R.T.
        • Tam H.S.
        • Jerlin E.
        A retrospective analysis of 50 consecutive Charcot diabetic salvage reconstructions.
        J Foot Ankle Surg. 2009; 48: 30-38
        • Lamm B.M.
        • Gottlieb H.D.
        • Paley D.
        A two-stage percutaneous approach to Charcot diabetic foot reconstruction.
        J Foot Ankle Surg. 2010; 49: 517-522
        • Altindas M.
        • Kilic A.
        • Ceber M.
        A new limb-salvaging technique for the treatment of late stage complicated Charcot foot deformity: two-staged Boyd's operation.
        Foot Ankle Surg. 2012; 18: 190-194
        • Cullen B.D.
        • Weinraub G.M.
        • Van Gompel G.
        Early results with use of the midfoot fusion bolt in Charcot arthropathy.
        J Foot Ankle Surg. 2013; 52: 235-238
        • Dalla Paola L.
        • Volpe A.
        • Varotto D.
        • Postorino A.
        • Brocco E.
        • Senesi A.
        • Merico M.
        • De Vido D.
        • Da Ros R.
        • Assaloni R.
        Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure.
        Foot Ankle Int. 2007; 28: 967-970
        • Dalla Paola L.
        • Brocco E.
        • Ceccacci T.
        • Ninkovic S.
        • Sorgentone S.
        • Marinescu M.G.
        • Volpe A.
        Limb salvage in Charcot foot and ankle osteomyelitis: combined use single stage/double stage of arthrodesis and external fixation.
        Foot Ankle Int. 2009; 30: 1065-1070
        • DiDomenico L.A.
        • Brown D.
        Limb salvage: revision of failed intramedullary nail in hindfoot and ankle surgery in the diabetic neuropathic patient.
        J Foot Ankle Surg. 2012; 51: 523-527
        • El-Gafary K.A.
        • Mostafa K.M.
        • Al-Adly W.Y.
        The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame: early results.
        J Bone Joint Surg Br. 2009; 91: 1322-1325
        • Eschler A.
        • Wussow A.
        • Ulmar B.
        • Mittlmeier T.
        • Gradl G.
        Intramedullary medial column support with the midfoot fusion bolt (MFB) is not sufficient for osseous healing of arthrodesis in neuroosteoarthropathic feet.
        Injury. 2014; 45: S38-S43
        • Grant W.P.
        • Garcia-Lavin S.
        • Sabo R.
        Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis.
        J Foot Ankle Surg. 2011; 50: 182-189
        • Illgner U.
        • Budny T.
        • Frohne I.
        • Osada N.
        • Siewe J.
        • Wetz H.H.
        Clinical benefit and improvement of activity level after reconstruction surgery of Charcot feet using external fixation: 24-months results of 292 feet.
        BMC Musculoskelet Disord. 2014; 15: 392
        • Mittlmeier T.
        • Klaue K.
        • Haar P.
        • Beck M.
        Should one consider primary surgical reconstruction in Charcot arthropathy of the feet?.
        Clin Orthop Relat Res. 2010; 468: 1002-1011
        • Nielson D.L.
        • Armstrong D.G.
        The natural history of Charcot's neuroarthropathy.
        Clin Podiatr Med Surg. 2008; 25: 53-62
        • Pawar A.
        • Dikmen G.
        • Fragomen A.
        • Rozbruch S.R.
        Antibiotic-coated nail for fusion of infected Charcot ankles.
        Foot Ankle Int. 2013; 34: 80-84
        • Pinzur M.S.
        Neutral ring fixation for high-risk nonplantigrade Charcot midfoot deformity.
        Foot Ankle Int. 2007; 28: 961-966
        • Pinzur M.S.
        Use of platelet-rich concentrate and bone marrow aspirate in high-risk patients with Charcot arthropathy of the foot.
        Foot Ankle Int. 2009; 30: 124-127
        • Pinzur M.S.
        • Gil J.
        • Belmares J.
        Treatment of osteomyelitis in Charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation.
        Foot Ankle Int. 2012; 33: 1069-1074
        • Siebachmeyer M.
        • Boddu K.
        • Bilal A.
        • Hester T.W.
        • Hardwick T.
        • Fox T.P.
        • Edmonds M.
        • Kavarthapu V.
        Outcome of one-stage correction of deformities of the ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail.
        Bone Joint J. 2015; 97-B: 76-82
        • Wiewiorski M.
        • Yasui T.
        • Miska M.
        • Frigg A.
        • Valderrabano V.
        Solid bolt fixation of the medial column in Charcot midfoot arthropathy.
        J Foot Ankle Surg. 2013; 52: 88-94
        • Wukich D.K.
        • Belczyk R.J.
        • Burns P.R.
        • Frykberg R.G.
        Complications encountered with circular ring fixation in persons with diabetes mellitus.
        Foot Ankle Int. 2008; 29: 994-1000
        • Yousry A.H.
        • Abdalhady A.M.
        Management of diabetic neuropathic ankle arthropathy by arthrodesis using an Ilizarov frame.
        Acta Orthop Belg. 2010; 76: 821-826
        • Zgonis T.
        • Roukis T.S.
        • Lamm B.M.
        Charcot foot and ankle reconstruction: current thinking and surgical approaches.
        Clin Podiatr Med Surg. 2007; 24: 505-517
        • Burns P.R.
        • Wukich D.K.
        Surgical reconstruction of the Charcot rearfoot and ankle.
        Clin Podiatr Med Surg. 2008; 25: 95-120
        • Wukich D.K.
        • Sung W.
        Charcot arthropathy of the foot and ankle: modern concepts and management review.
        J Diabetes Complications. 2009; 23: 409-426
        • Lowery N.J.
        • Woods J.B.
        • Armstrong D.G.
        • Wukich D.K.
        Surgical management of Charcot neuroarthropathy of the foot and ankle: a systematic review.
        Foot Ankle Int. 2012; 33: 113-121
        • Eichenholtz S.N.
        Charcot Joints.
        Charles C Thomas, Springfield, IL1966
        • Frykberg R.G.
        The High Risk Foot in Diabetes Mellitus.
        Churchill Livingstone, New York1991