Charcot

UNLABELLED: Charcot arthropathy commonly affects the midfoot and is often an extremely difficult and challenging surgical problem. Operative treatment with medial column arthrodesis using large intramedullary bolts or screws is an evolving and increasingly popular technique called "beaming." The technique is described here. LEVEL OF EVIDENCE: Level V, expert opinion.

During a 10-year period, 237 patients (129 women, 108 men) with a diagnosis of neuropathic (Charcot) arthropathy of the foot and ankle were treated in a tertiary care university hospital medical center. During this period, 115 of the patients (48.5%) were treated nonoperatively as outpatients with local skin and nail care, accommodative shoe wear, and custom foot orthoses. A total of 120 (50.6%) underwent 143 operations. Surgery included 21 major limb amputations, 29 ankle fusions, 26 hindfoot fusions, 23 exostectomies, and 23 debridements for osteomyelitis...

To develop a classification of midtarsus deformities, clinical examination and weightbearing radiographs were used to evaluate 131 feet in 109 patients (average age, 59+/-11 years) with those deformities. Patients were classified into four types based on anatomic location of the maximum deformity. Type I (N=43) showed deformity at the metatarsocuneiform joints medially and the fourth and fifth metatarsocuboid joints laterally, with plantarmedial and/or medial prominence. Type II (N= 60) had deformity at the naviculocuneiform joint medially and the fourth and fifth metatarsocuboid joints laterally; plantarlateral prominence was characteristic, although one-third had isolated or additional medial prominences...

Twenty-seven feet with neuroarthropathic fracture resulting in significant deformity were treated with surgical reconstruction. The average age of the patients was 57 years with 21 patients having diabetes mellitus an average of 24 years. Five patterns of midfoot collapse were identified. The most common patterns involved abduction and dorsal displacement of the forefoot with equinus of the hindfoot. Preoperative evaluation included a medical assessment, adequate control of blood sugar, and a comprehensive vascular evaluation...

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BACKGROUND: Treatment of patients with Charcot midfoot destruction is a difficult and increasingly common clinical problem. The pathoanatomical features of Charcot neuropathy have been evaluated in only a few studies. This study evaluated whether medial navicular subluxation (adduction of the navicular on the talus) is a radiographic finding present in patients with Charcot neuroarthropathy. METHODS: A retrospective review of 143 consecutive patients diagnosed with Charcot arthropathy of the foot from January 2004 to May 2011 was performed...

BACKGROUND: Charcot neuroarthropathy (CN) of the foot and ankle is an extremely challenging clinical dilemma and surgical management can be highly complicated. The current literature on this topic is comprised of manuscripts that are retrospective case series and expert opinions. Furthermore, surgery in patients with CN of the foot and ankle is guided by studies with low levels of evidence to support our current surgical practices. METHODS: A Medline/CINAHL search was performed and a systematic review of articles discussing the surgical management of CN was undertaken...

BACKGROUND: Plantar midfoot ulceration in diabetic patients with midfoot Charcot neuroarthropathy is a risk factor for infection that can require amputation. The aim of this study was to determine a simple radiographic predictor of the individual risk of subsequent ulcer formation in this group of patients. MATERIALS AND METHODS: A retrospective review of all patients seen at our institution between January 1998 and July 2004 with diabetic Charcot neuroarthropathy was performed...