The impact of Syme amputation in surgical treatment of patients with diabetic foot syndrome and Charcot-neuro-osteoarthropathy.

INTRODUCTION: Charcot-neuro-osteoarthropathy with its severe destruction of bones remains a challenge for physicians and surgeons. The aim of the study was to characterise a patient population treated in a specialised foot care centre who underwent surgical treatment for their diabetic foot syndrome. Special attention was paid to patients who suffered from Charcot-neuro-osteoarthropathy and the impact of Syme amputation if amputation of the foot was inevitable.

MATERIALS AND METHODS: A total of 121 patients with diabetic foot syndrome and ulcerations underwent an interdisciplinary strategy for diagnostic and therapeutic procedures including MRI and surgical interventions. If peripheral arterial vessel disease was present, revascularisation by distal bypass grafting was done before the orthopaedic intervention. Some 24% showed the typical neuro-osteoarthropathy with severe bone destruction. In 8 cases amputation of the foot was performed using the Syme technique.

RESULTS: In our population the short-term results (follow-up 12 months, 20% lost to follow-up) are good, only 4% of the patients required further surgery on the same foot. In all patients with Charcot feet, plain radiographs showed the typical radiographic signs of the disease, and MRI was most helpful to detect abscess formations. The typical clinical problems of patients with Charcot disease are pointed out, and conservative and surgical treatment options are discussed. All patients with Syme amputation did well, wound healing and weight-bearing of the limb were accomplished.

CONCLUSION: The crucial diagnostic tool for decision-making in diabetic foot syndrome was MRI, which normally shows osteomyelitis with high sensitivity and specificity. In patients with Charcot-neuro-osteoarthropathy, the bone marrow oedema of the involved parts of the skeleton might misleadingly suggest the diagnosis of osteomyelitis. If amputation is inevitable in severe abscess formation combined with instability and perforation of the dislocated and destroyed bones in Charcot-neuro-osteoarthropathy, these patients might benefit from a foot amputation according to the technique Syme described. For this procedure the blood supply of the posterior tibial artery is essential. All these patients were able to walk without support. The material presented helps to generate hypotheses for further prospective studies.