Surgical Treatment Options for the Diabetic Charcot Midfoot Deformity

Alrashidi, Yousef; Hügle, Thomas; Wiewiorski, Martin; Herrera-Pérez, Mario; Valderrábano, Víctor

doi:10.1016/j.cpm.2016.07.006

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…With regular dressing, all wounds achieved healing eventually. The drainage rate is similar with the former studies about chronic osteomyelitis and varies from 4.2 to 32% [13, 17, 30]. Other studies have reported the prolonged postoperative leakage in treating chronic osteomyelitis after using antibiotic-impregnated calcium sulfate, but achieving healing with appropriate wound care [13, 31].…”

Section: Discussionsupporting

confidence: 81%

Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis

Qin

Zhou

Song

et al. 2019

BMC Musculoskelet Disord

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Background Managing with diabetic foot osteomyelitis (DFO) is challenging. Even after infective bone resection and thorough debridement, DFO is still difficult to cure and has a high recurrence rate. This retrospective study aims to compare the outcomes of two treatment methods, infected bone resection combined with adjuvant antibiotic-impregnated calcium sulfate and infected bone resection alone, for the treatment of diabetic foot osteomyelitis. Methods Between 2015 to 2017, 48 limbs (46 patients) with DFO met the criteria were included for assessment. 20 limbs (18 patients) were included in the calcium sulfate group (the CS group) in which vancomycin and/or gentamicin-impregnated calcium sulfate was used as an adjuvant after infected bone resection while 28 limbs (28 patients) as the control group were undergone infected bone resection only. Systemic antibiotics, postoperative wound care and offloading were continued to be applied following surgery in both groups. The time to healing, healing rate, recurrence rate and amputation rate were compared between the two groups. Results In total, 90% (18/20) limbs in the CS group as compared to 78.6% (22/28) infected limbs in the control group went to heal ( P = 0.513). The Mean time to healing was 13.3 weeks in the CS group and 11.2 weeks in control group ( P = 0.132). Osteomyelitis recurrence rate was 0% (0/18) in the CS group and 36.4% (8/22) in the control group ( P = 0.014). Postoperative leakage in calcium sulfate group was 30.0% (6/20) with a mean duration of 8.5 weeks. Amputation rate in the control group was 7.1% (2/28) compared to 0% (0/20) in the CS group ( P = 0.153). Conclusions Antibiotic-impregnated calcium sulfate as an adjuvant prevents the recurrence of DFO but cannot improve the healing rate, reduce the postoperative amputation rate or shorten the time to healing. Prolonged postoperative leakage as the most common complication can be managed with regular dressing. Level of Evidence III, Retrospective Comparative Study.

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Section: Discussionsupporting

confidence: 81%

Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis

Qin

Zhou

Song

et al. 2019

BMC Musculoskelet Disord

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“…Surgical treatment of Charcot arthropathy still remains a great challenge, especially when complicated by a breakdown of the foot arch with imminent or already present plantar ulcerations. Therefore, various treatment regimens exist, but evidence for the best clinical strategy is still missing [ 1 , 3 , 9 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, current treatment protocols highlight the importance of surgical treatment of the hindfoot equinus position by lengthening the Achilles tendon either open or minimally invasively [ 1 , 3 , 10 , 12 , 28 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, treatment of hindfoot equinus is generally accepted to reduce plantar pressure and promote healing of plantar ulcerations with and without Charcot neuropathy. Therefore, in almost all current treatment regimes, correction of the pathological equinus position of the hindfoot represents one of the key elements when surgical reconstruction of the collapsed bony structures is planned [ 1 , 3 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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High rate of complications after corrective midfoot/subtalar arthrodesis and Achilles tendon lengthening in Charcot arthropathy type Sanders 2 and 3

Regauer¹,

Grasegger²,

Fürmetz³

et al. 2022

International Orthopaedics (SICOT)

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Purpose Corrective midfoot resection arthrodesis is the standard treatment of Charcot arthropathy type Sanders 2 and 3 with severe dislocation. In order to critically evaluate the effect of surgical correction, a retrospective analysis of our patient cohort was performed. Hereby, special emphasis was set on the analysis of the pre- and post-operative equinus position of the hindfoot. Methods Retrospectively, all patients (n = 82) after midfoot resection arthrodesis in Charcot type Sanders 2 or 3 were included. Complications were recorded, and the mean complication-free interval was calculated. Additionally, the calcaneal pitch as well as Meary’s angle were measured pre- and post-operatively and in case of complications. Results Overall complication rate was 89%. Revision surgery was necessary in 46% of all patients. The mean complication-free interval was 285 days (0–1560 days). Calcaneal pitch and Meary’s angle significantly improved after operation but returned to pre-operative values after onset of complications. Achilles tendon lengthening showed no significant effects on the mean complication-free interval. Conclusion Operative treatment of Charcot arthropathy remains a surgical challenge with high complication rates. Surgical correction of equinus position has been highlighted for successful treatment but was not able to prevent complications in this study, which is demonstrated by the recurrent decrease of the calcaneal pitch in cases of reoperation. Therefore, as a conclusion of our results, our treatment algorithm changed towards primarily addressing the equinus malpositioning of the hindfoot by corrective arthrodesis of the hindfoot.

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Case #29: Revision of Neuropathic Lis Franc Joint Dislocation with Trans-Pedal Wedge Arthrodesis

Visser

2022

Challenges in Foot and Ankle Reconstructive Surgery

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Surgical Treatment Options for the Diabetic Charcot Midfoot Deformity

Cited by 8 publications

References 16 publications

Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis

Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis

High rate of complications after corrective midfoot/subtalar arthrodesis and Achilles tendon lengthening in Charcot arthropathy type Sanders 2 and 3

Case #29: Revision of Neuropathic Lis Franc Joint Dislocation with Trans-Pedal Wedge Arthrodesis

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