ABSTRACT
The primary aim of this study is to compare the preoperative risk factors and postoperative
outcomes between Charcot neuroarthropathy patients with dislocation versus purely
fracture pattern breakdown. The secondary aim is to compare the same factors between
Charcot neuroarthropathy patients with dislocation versus fracture-dislocation pattern
breakdown. A total of 55 patients with forefoot, midfoot, or hindfoot Charcot Neuroarthopathy
were assessed at a mean follow up of 2.99 years. Bivariate analysis compared preoperative
risk factors and postoperative outcomes, and segmented multivariable regression analysis
was performed. Dislocation pattern Charcot had statistically significant higher rates
of broken hardware (p = .05), mean age (p = .01), and revisional exostectomy (p = .01) compared to pure fracture pattern Charcot. Dislocation pattern Charcot was
12 times more likely to have revisions exostectomy (odds ratio [OR] 12.0, 95% confidence
interval [CI] 1.84-78.37), and was 8 times more likely to have osteomyelitis (OR 7.8,
95% CI 1.4-42.7, p = .02) compared to the fracture-dislocation pattern Charcot. The patients with pure
fracture pattern Charcot were 58.8 times more likely to have Charcot breakdown involvement
of the talonavicular joint compared to the dislocation pattern cohort (OR 58.83, 95%
CI 1.1-3220.3). Involvement of the talonavicular joint, in the fracture pattern Charcot
associate with medial column collapse occurring at the onset of Charcot breakdown.
The dislocation pattern in Charcot Neuroarthropathy demonstrated a higher propensity
for residual collapse as demonstrated by the higher rates of broken hardware, osteomyelitis,
and need for revisional exostectomy.
Level of Clinical Evidence
Keywords
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References
- The pathogenesis of Charcot neuroarthropathy: current concepts.Diabet Foot Ankle. 2012; 3: 1-4
- The Charcot foot in diabetes.Diabetes Care. 2011; 34: 2123-2129
- Neuroarthropathy in diabetes: pathogenesis of Charcot arthropathy.Bone Joint Res. 2018; 7: 373-378
- Charcot neuroarthropathy in patients with diabetes: an updated systematic review of surgical management.J Foot Ankle Surg. 2016; 55: 586-590
- Alcohol-induced neuroarthropathy in the foot: a case series and review of literature.J Foot Ankle Surg. 2008; 47: 118-124
- Charcot arthropathy of the foot and ankle.Foot Ankle Int. 2016; 37: 1255-1263
- Osteopenia: a bone disorder associated with diabetes mellitus.J Bone Miner Metab. 2005; 23: 58-68
- Middle-aged premenopausal women with type 1 diabetes have lower bone mineral density and calcaneal quantitative ultrasound than nondiabetic women.Diabetes care. 2006; 29: 306-311
- Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus.JAMA. 1992; 268: 3333-3337
- Osteopenia associated with non-insulin-dependent diabetes mellitus: what are the causes?.Diabetes Res Clin Pract. 1994; 23: 43-54
- Bone mineral metabolism is normal in non-insulin-dependent diabetes mellitus.J Diabetes Complications. 1996; 10: 201-205
- Loss of RAGE defense: a cause of Charcot neuroarthropathy?.Diabetes Care. 2011; 34: 1617-1621
- Calcaneal ultra-sonomentry in patients with Charcot osteoarthropathy and its relationship with densitometry in the lumbar spine and femoral neck and with markers of bone turnover.Diabet Med. 2001; 18: 495-500
- Charcot collapse: does collapse pattern dictate osseous metabolism?.Foot Ankle Spec. 2017; 10: 428-434
- Pattern of diabetic neuropathic arthropathy associated with the peripheral bone mineral density.J Bone Joint Surg Br. 2004; 86: 378-383
- Osteoporosis prevention, diagnosis, and therapy.JAMA. 2001; 285: 785-795
- The acquired midtarsus deformity classification system–interobserver reliability and intraobserver reproducibility.Foot Ankle Int. 2002; 23: 30-36
- Charcot salvage of the foot and ankle using external fixation.Foot Ankle Clin. 2008; 13: 157-173
- Prognostic scoring system for patients undergoing reconstructive foot and ankle surgery for charcot neuroarthropathy: the Charcot reconstruction preoperative prognostic score.J Foot Ankle Surg. 2017; 57: 451-455
- Epidemiology of the Charcot foot.Clin Podiatr Med Surg. 2008; 5: 17-28
- Radiographic measures as a predictor of ulcer formation in diabetic Charcot midfoot.Foot Ankle Int. 2008; 29: 568-573
- Precision of foot alignment measures in Charcot arthropathy.Foot Ankle Int. 2011; 32: 867-872
- Radiographic analysis of diabetic midfoot Charcot neuroarthropathy with and without midfoot ulceration.Foot Ankle Int. 2014; 35: 1108-1115
- A systematic review of angular deformities in Charcot neuroarthropathy.J Foot Ankle Surg. 2020; (Article in the press)
- A comparison of vitamin D levels in nondiabetic and diabetic patient populations.J Am Podiatr Med Assoc. 2009; 99: 107
- Early foot structural changes after lateral column exostectomy in patients with Charcot foot.Int J Low Extrem Wounds. 2019; 18: 129-134
- Optimizing results in diabetic Charcot reconstruction.Clin Podiatr Med Surg. 2019; 36: 469-481
- Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care center.Singapore Med J. 2016; 57: 198-203
- Risk factors for Charcot foot.Arch Endocrinol Metab. 2015; 59: 226-230
- Risk factors of charcot neuroarthropathy development in patients with type 2 diabetes.Exp Clin Endocrinol Diabetes. 2014; 122: 31-34
- Charcot arthropathy of the foot and ankle in patients with idiopathic neuropathy.Foot Ankle Int. 2014; 35: 996-1001
- Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation.Am J Sports Med. 1991; 19: 217-225
- Ligament structure, physiology and function.J Musculoskelet Neuronal Interact. 2004; 4: 199-201
- Early medial collateral ligament scars have inferior creep behaviour.J Orthop Res. 2000; 18: 238-246
- Superconstructs in the treatment of Charcot foot deformity: plantar plating, locked plating, and axial screw fixation.Foot Ankle Clin. 2009; 14: 393-407
- Charcot arthropathy of the foot and ankle: modern concepts and management review.J Diabetes Complications. 2009; 3: 409-426
- Offloading treatment is linked to activation of proinflammatory cytokines and start of bone repair and remodeling in Charcot arthropathy patients.J Foot Ankle Res. 2015; 8: 72
- Charcot arthropathy and immobilization in a weight-bearing total contact cast.J Bone Joint Surg Am. 2008; 90: 754-759
Article info
Publication history
Published online: July 25, 2021
Footnotes
Financial Disclosure: This study was supported by the University of Maryland School of Medicine Department of Orthopaedics, Jacob Wynes, is the guarantor of the content of this manuscript
Conflict of Interest: Jacob Wynes, DPM, MS, FACFAS reports he is on the speaker's bureau of Smith & Nephew and consultant for Orthofix. Nicole K. Cates, DPM, AACFAS; Jonathan Furmanek, DPM; Korey S. Dubois, DPM, AACFAS: have no financial disclosures, commercial associations, or any other conditions posing a conflict of interest to report.
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