A Two-Stage Percutaneous Approach to Charcot Diabetic Foot Reconstruction

• Published in: The Journal of foot and ankle surgery 2010-11, Vol.49 (6), p.517-522
• Main Authors: Lamm, Bradley M., DPM, Gottlieb, H. David, DPM, Paley, Dror, MD
• Format: Article
• Language: English
• Subjects: Achilles Tendon - surgery; Adult; Aged; Arthrodesis - methods; Arthropathy, Neurogenic - diagnostic imaging; Arthropathy, Neurogenic - surgery; Associated diseases and complications; Biological and medical sciences; Bone Screws; deformity; diabetes; Diabetes. Impaired glucose tolerance; Diabetic Foot - surgery; Diseases of the osteoarticular system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Equinus Deformity - surgery; Etiopathogenesis. Screening. Investigations. Target tissue resistance; external fixation; External Fixators; Female; Fluoroscopy; Foot Bones - surgery; Foot Joints - diagnostic imaging; Foot Joints - surgery; Humans; Male; Medical sciences; Middle Aged; Muscle, Skeletal - surgery; Orthopedics; rocker bottom foot; surgery; Taylor spatial frame
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2010.07.014

Abstract The goals of Charcot deformity correction are to restore osseous alignment, regain pedal stability, and prevent ulceration. Traditional reconstructive surgical approaches involve large, open incisions to remove bone and the use of internal fixation to attempt to fuse dislocated joints. Such operations can result in shortening of the foot and/or incomplete deformity correction, fixation failure, incision healing problems, infection, and the longterm use of casts or braces. We recommend a minimally invasive surgical technique for the treatment of Charcot deformity, which we performed on 11 feet in 8 patients. Osseous realignment was achieved through gradual distraction of the joints with external fixation, after which minimally invasive arthrodesis was performed with rigid internal fixation. Feet were operated on at various stages of Charcot deformity: Eichenholtz stage I (1 foot), Eichenholtz stage II (6 feet), and Eichenholtz stage III (4 feet). When comparing the average change in preoperative and postoperative radiographic angles, the transverse plane talar-first metatarsal angle (P = .02), sagittal plane talar-first metatarsal angle (P = .008), and calcaneal pitch angle (P = .001) were all found to be statistically significant. Complications included 3 operative adjustments of external or internal fixation, 4 broken wires or half-pins, 2 broken rings, and 11 pin tract infections. Most notably, no deep infection, no screw failure, and no recurrent ulcerations occurred and no amputations were necessary during an average follow-up of 22 months. Gradual Charcot foot correction with the Taylor spatial frame plus minimally invasive arthrodesis is an effective treatment.