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Surgical versus accommodative treatment for Charcot arthropathy of the midfoot.
Foot Ankle Int. 2004 Aug; 25(8):545-9.FA

Abstract

BACKGROUND

The treatment of Charcot foot arthropathy is one of the most controversial issues facing orthopaedic foot and ankle surgeons. Although current orthopaedic textbooks are in almost universal agreement that treatment should be nonoperative, accommodating the deformity with orthotic methods, most peer-reviewed clinical studies recommend early surgical correction of the deformity. In a university health system orthopaedic foot and ankle clinic with a special interest in diabetic foot disorders, a moderate approach evolved for management of this difficult patient population.

METHODS

Patients with Charcot arthropathy and plantigrade feet were treated with accommodative orthotic methods. Those with nonplantigrade feet were treated with surgical correction of the deformity, followed by long-term management with commercial therapeutic footwear. The desired outcome for both groups was long-term management with standard, commercially available, therapeutic depth-inlay shoes and custom-fabricated accommodative foot orthoses. During a 6-year period, 198 patients (201 feet) were treated for diabetes-associated Charcot foot arthropathy. The location of the deformity was in the midfoot in 147 feet, in the ankle in 50, and in the forefoot in four.

RESULTS

At a minimum 1-year follow-up, 87 of the 147 feet with midfoot disease (59.2%) achieved the desired endpoint without surgical intervention. Sixty (40.8%) required surgery. Corrective osteotomy with or without arthrodesis was attempted in 42, while debridement or simple exostectomy was attempted in 18 feet. Three patients had initial amputation (one partial foot amputation, one Syme ankle disarticulation, and one transtibial amputation), and five had amputation (two Syme ankle disarticulations and three transtibial amputations) after attempted salvage failed.

CONCLUSION

Using a simple treatment protocol with the desired endpoint being long-term management with commercially available, therapeutic footwear and custom foot orthoses, more than half of patients with Charcot arthropathy at the midfoot level can be successfully managed without surgery.

Authors+Show Affiliations

Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA. mpinzu1@lumc.edu

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15363375

Citation

Pinzur, Michael. "Surgical Versus Accommodative Treatment for Charcot Arthropathy of the Midfoot." Foot & Ankle International, vol. 25, no. 8, 2004, pp. 545-9.
Pinzur M. Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int. 2004;25(8):545-9.
Pinzur, M. (2004). Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot & Ankle International, 25(8), 545-9.
Pinzur M. Surgical Versus Accommodative Treatment for Charcot Arthropathy of the Midfoot. Foot Ankle Int. 2004;25(8):545-9. PubMed PMID: 15363375.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. A1 - Pinzur,Michael, PY - 2004/9/15/pubmed PY - 2004/12/22/medline PY - 2004/9/15/entrez SP - 545 EP - 9 JF - Foot & ankle international JO - Foot Ankle Int VL - 25 IS - 8 N2 - BACKGROUND: The treatment of Charcot foot arthropathy is one of the most controversial issues facing orthopaedic foot and ankle surgeons. Although current orthopaedic textbooks are in almost universal agreement that treatment should be nonoperative, accommodating the deformity with orthotic methods, most peer-reviewed clinical studies recommend early surgical correction of the deformity. In a university health system orthopaedic foot and ankle clinic with a special interest in diabetic foot disorders, a moderate approach evolved for management of this difficult patient population. METHODS: Patients with Charcot arthropathy and plantigrade feet were treated with accommodative orthotic methods. Those with nonplantigrade feet were treated with surgical correction of the deformity, followed by long-term management with commercial therapeutic footwear. The desired outcome for both groups was long-term management with standard, commercially available, therapeutic depth-inlay shoes and custom-fabricated accommodative foot orthoses. During a 6-year period, 198 patients (201 feet) were treated for diabetes-associated Charcot foot arthropathy. The location of the deformity was in the midfoot in 147 feet, in the ankle in 50, and in the forefoot in four. RESULTS: At a minimum 1-year follow-up, 87 of the 147 feet with midfoot disease (59.2%) achieved the desired endpoint without surgical intervention. Sixty (40.8%) required surgery. Corrective osteotomy with or without arthrodesis was attempted in 42, while debridement or simple exostectomy was attempted in 18 feet. Three patients had initial amputation (one partial foot amputation, one Syme ankle disarticulation, and one transtibial amputation), and five had amputation (two Syme ankle disarticulations and three transtibial amputations) after attempted salvage failed. CONCLUSION: Using a simple treatment protocol with the desired endpoint being long-term management with commercially available, therapeutic footwear and custom foot orthoses, more than half of patients with Charcot arthropathy at the midfoot level can be successfully managed without surgery. SN - 1071-1007 UR - https://www.unboundmedicine.com/medline/citation/15363375/Surgical_versus_accommodative_treatment_for_Charcot_arthropathy_of_the_midfoot_ L2 - https://journals.sagepub.com/doi/10.1177/107110070402500806?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -