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      Midfoot Charcot Arthropathy: Overview and Surgical Management

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          ABSTRACT

          Midfoot Charcot arthropathy is a progressive deforming condition characterized by recurrent ulceration leading to high morbidity and amputation with lack of timely intervention. Nonoperative treatment is largely reserved for acute phase disease. Recent trend in management is early surgical interventions which could alter deforming forces and prevent deformity progression, as well as surgeries which provide osseously stable plantigrade foot. However, there are no clear-cut evidence-based guidelines regarding timing of interventions and method of techniques in surgical stabilization. This study discusses about surgical technique in the management of midfoot Charcot.

          How to cite this article

          Silvampatti S, Nagaraja HS, Rajasekaran S. Midfoot Charcot Arthropathy: Overview and Surgical Management. J Foot Ankle Surg (Asia-Pacific) 2016;3(2):97-106.

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          Most cited references 80

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          Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort.

          To report the incidence of diabetes-related lower-extremity complications in a cohort of patients enrolled in a diabetes disease management program. We evaluated screening results and clinical outcomes for the first 1,666 patients enrolled in a disease management program for a period of 24 months (50.3% men, aged 69.1 +/- 11.1 years). The incidence of ulceration, infection, amputation, and lower-extremity bypass was 68.4, 36.5, 5.9, and 7.7 per 1,000 persons with diabetes per year. Amputation incidence was higher in Mexican Americans than in non-Hispanic whites (7.4/1,000 vs. 4.1/1,000; P = 0.003, odds ratio [OR] 1.8, 95% CI 1.2-2.7). The amputation-to-ulcer ratio was 8.7%. The incidence of Charcot arthropathy was 8.5/1,000 per year. Charcot was more common in non-Hispanic whites than in Mexican Americans (11.7/1,000 vs. 6.4/1,000; P = 0.0001, 1.8, 1.3-2.5). The prevalence of peripheral vascular disease was 13.5%, with no significant difference based on ethnicity (P = 0.3). There was not a significant difference in incidence of foot infection (P = 0.9), lower-extremity bypass (P = 0.3), or ulceration (P = 0.1) based on ethnicity. However, there were more failed bypasses in Mexican Americans (33%) than in non-Hispanic whites (7.1%). Mexican Americans were 3.8 times more likely to have a failed bypass (leading to an amputation) or be diagnosed as "nonbypassable" than non-Hispanic whites (75.0 vs. 44.0%; P = 0.01, 3.8, 1.2-11.8). The incidence of amputation is higher in Mexican Americans, despite rates of ulceration, infection, vascular disease, and lower-extremity bypass similar to those of non-Hispanic whites. There may be factors associated with failed or failure to bypass that mandate further investigation.
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            Charcot arthropathy of the foot and ankle: modern concepts and management review.

            Charcot arthropathy (Charcot neuroarthropathy, diabetic neuropathic osteoarthropathy, or neuropathic arthropathy) remains a poorly understood disease, although recent research has improved our level of knowledge regarding its etiology and treatment. The effects of Charcot arthropathy are almost exclusively seen in the foot and ankle, and the diagnosis is commonly missed upon initial presentation. It has been well established that this complication of diabetes mellitus severely reduces the overall quality of life and dramatically increases the morbidity and mortality of patients. However, there are few high-level evidence studies to support management and treatment options at this point in time. The goal of this study is to evaluate the modern concepts of Charcot arthropathy through a review of the available literature and to integrate a perspective of management from the authors' extensive experience.
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              The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic.

              The aim of this longitudinal study was to report on the clinical characteristics and treatment course of acute Charcot's arthropathy at a tertiary care diabetic foot clinic. Fifty-five diabetic subjects, with a mean age of 58.6 +/- 8.5 years, were studied. All patients were treated with serial total contact casting until quiescence. Following casting and before transfer to prescription footwear, patients were eased into unprotected weightbearing via a removable cast walker. This cohort was followed for their entire treatment course and for a mean 92.6 +/- 33.7 weeks following return to shoes. Pain was the most frequent presenting complaint in these otherwise insensate patients (76%). The mean duration of casting was 18.5 +/- 10.6 weeks. Patients returned to footwear in a mean 28.3 +/- 14.5 weeks. Nine per cent of the population had bilateral arthropathy. These subjects were casted significantly longer than the unilateral group (p < 0.02). Surgery was performed on 25 % of patients, with approximately two-thirds of these procedures involving plantar exostectomies and one-third fusions of affected joints. Patients receiving surgery remained casted significantly longer than non-surgical patients (p < 0.05). Additionally, men were casted longer than women (p < 0.008). Acute Charcot's arthropathy requires prompt, uncompromising reduction in weightbearing stress. Our data show that the ambulatory total contact cast is very effective for this. Regardless of the specific treatment method instituted, it is imperative that appropriate and aggressive treatment be undertaken immediately following diagnosis to help prevent progression to a profoundly debilitating, limb-threatening deformity.
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                Author and article information

                Contributors
                Role: Consultant
                Role: Registrar
                Role: Head
                Journal
                JFASAP
                Journal of Foot and Ankle Surgery (Asia Pacific)
                JFASAP
                Jaypee Brothers Medical Publishers
                2348-280X
                2394-7705
                July-December 2016
                : 3
                : 2
                : 97-106
                Affiliations
                [1-3 ]Department of Orthopedics, Ganga Hospital, Coimbatore Tamil Nadu, India
                Author notes
                Sundararajan Silvampatti, Consultant Department of Orthopedics, Ganga Hospital, Coimbatore, Tamil Nadu, India, Phone: +914222485000, e-mail: sundarbone70@ 123456hotmail.com
                Article
                10.5005/jp-journals-10040-1056
                Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.

                Creative Commons Attribution 4.0

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