Research Article| Volume 59, ISSUE 6, P1219-1223, November 2020

Charcot Midfoot Reconstruction: Does Subtalar Arthrodesis or Medial Column Fixation Improve Outcomes?


      Charcot neuroarthropathy is a complication of neuropathy often secondary to diabetes mellitus and most commonly affects the midfoot. In these patients, reconstruction of the foot may be required for limb salvage. A superconstruct technique has previously been described using intramedullary beaming fixation of the midfoot and hindfoot to span the zone of injury. Inclusion of the subtalar joint in the arthrodesis construct is not consistently performed among different surgeons. The aim of this study was to describe midfoot beaming constructs and postoperative complications after midfoot reconstruction with and without subtalar arthrodesis. We reviewed medical records of patients who underwent midfoot Charcot reconstruction with an intramedullary beaming superconstruct. Patients included in the study had at least 3 months of follow-up and had Sanders-Frykberg II/III classification of Charcot neuroarthropathy. Postoperative radiographs were evaluated for evidence of hardware failure at the latest follow-up evaluation. The main variables of interest were: hardware failure or nonunion requiring revision operation, deep infection, and unplanned reoperation. Thirty patients who underwent midfoot reconstruction were included. The mean follow-up was 67.4 ± 25.9 weeks. Twenty-two (73.3%) patients had concomitant subtalar arthrodesis and midfoot beaming. Overall complications were lower in patients with subtalar arthrodesis (40.9%) than those without subtalar arthrodesis (75%) resulting in an odds ratio of 0.271 (0.042-1.338, p = .146). Furthermore, increased number of screws used in the midfoot construct was negatively correlated with complications (r = −0.44, p = .01). An intramedullary midfoot beaming superconstruct with subtalar arthrodesis has previously been proposed to provide better fixation after midfoot beaming Charcot neuroarthropathy reconstruction. Our results suggest including the subtalar joint as part of a superconstruct for the reconstruction of Sanders-Frykberg II/III Charcot results in an 80% lower complication rate than intramedullary beaming alone. We also found an increased number of screws used in the midfoot results in a lower complication rate.


      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 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


        • Charcot J
        Sur quelques arthropathies qai paraisant dependre d'une lesion du cervau on de la moelle epinere.
        Arch Physiol. 1868; ([in French]): 161-178
        • Jordan W
        Neuritic manifestations in diabetes mellitus.
        Arch Intern Med. 1936; 57: 307-336
        • Fauzi AA
        • Chung TY
        • Latif LA
        Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre.
        Singapore Med J. 2016; 57: 198-203
        • Pakarinen TK
        • Laine HJ
        • Maenpaa H
        • Mattila P
        • Lahtela J
        Long-term outcome and quality of life in patients with Charcot foot.
        Foot Ankle Surg. 2009; 15: 187-191
        • Kroin E
        • Schiff AP
        • Pinzur MS
        • Davis ES
        • Chaharbakhshi E
        • DiSilvio Jr, FA
        Functional impairment of patients undergoing surgical correction for Charcot foot arthropathy.
        Foot Ankle Int. 2017; 38: 705-709
        • Raspovic KR
        • Wukich DK
        Self-reported quality of life in patients with diabetes: a comparison of patients with and without Charcot neuroarthropathy.
        Foot Ankle Int. 2014; 35: 195-200
        • Kroin E
        • Chaharbakhshi EO
        • Schiff A
        • Pinzur MS
        Improvement in quality of life following operative correction of midtarsal Charcot foot deformity.
        Foot Ankle Int. 2018; 39: 808-811
        • Sammarco VJ
        Superconstructs in the treatment of Charcot foot deformity: plantar plating, locked plating and axial screw fixation.
        Foot Ankle Clin. 2009; 14: 393-407
        • Jones CP
        Beaming for Charcot foot reconstruction.
        Foot Ankle Int. 2015; 36: 853-859
        • Benjamini Y
        • Hochberg
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        J Roy Stat Soc Ser. 1995; B: 289-300
        • Grant WP
        • Garcia-Lavin S
        • Sabo R
        Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis.
        J Foot Ankle Surg. 2011; 50: 182-189