Tags

Type your tag names separated by a space and hit enter

Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy.
J Bone Joint Surg Am. 2009 Apr; 91(4):812-20.JB

Abstract

BACKGROUND

The failure of nonsurgical treatment of patients with midfoot and hindfoot deformity secondary to diabetic Charcot arthropathy may lead to a rocker-bottom foot deformity with recurrent or persistent plantar ulceration. We report our experience with realignment and extended fusion with primary use of a medial column screw for this midfoot deformity.

METHODS

From July 2001 through July 2005, we performed reconstructive surgery on fifteen adults with diabetes mellitus who had a severe neuropathic midfoot deformity consisting of a collapsed plantar arch with a rocker-bottom foot deformity. Thirteen had a nonhealing midfoot plantar ulcer. All underwent realignment and arthrodesis with a medial column screw; some required additional fixation techniques depending on the extent of the deformity. Outcome measures included ulcer and surgical wound-healing, radiographic results, complications, and the need for amputation.

RESULTS

The mean duration of clinical follow-up was forty-two months. Fourteen patients were able to walk, and there were no recurrent plantar ulcers. Thirteen patients were able to wear custom-made extra-depth, wide-toed shoes with molded inserts. One patient without prior ulceration had development of a deep infection that necessitated an amputation. Four feet had a nonunion, one of which was symptomatic requiring a revision to obtain union.

CONCLUSIONS

Surgical reconstruction of a collapsed neuropathic foot deformity is technically demanding, but a successful outcome can result in a plantigrade foot that is free of ulceration and abnormal pressure points and a patient who is able to walk. The procedure described has an acceptable degree of complications although it has a high rate of nonunion.

Authors+Show Affiliations

Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19339565

Citation

Assal, Mathieu, and Richard Stern. "Realignment and Extended Fusion With Use of a Medial Column Screw for Midfoot Deformities Secondary to Diabetic Neuropathy." The Journal of Bone and Joint Surgery. American Volume, vol. 91, no. 4, 2009, pp. 812-20.
Assal M, Stern R. Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. J Bone Joint Surg Am. 2009;91(4):812-20.
Assal, M., & Stern, R. (2009). Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. The Journal of Bone and Joint Surgery. American Volume, 91(4), 812-20. https://doi.org/10.2106/JBJS.G.01396
Assal M, Stern R. Realignment and Extended Fusion With Use of a Medial Column Screw for Midfoot Deformities Secondary to Diabetic Neuropathy. J Bone Joint Surg Am. 2009;91(4):812-20. PubMed PMID: 19339565.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. AU - Assal,Mathieu, AU - Stern,Richard, PY - 2009/4/3/entrez PY - 2009/4/3/pubmed PY - 2009/4/30/medline SP - 812 EP - 20 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 91 IS - 4 N2 - BACKGROUND: The failure of nonsurgical treatment of patients with midfoot and hindfoot deformity secondary to diabetic Charcot arthropathy may lead to a rocker-bottom foot deformity with recurrent or persistent plantar ulceration. We report our experience with realignment and extended fusion with primary use of a medial column screw for this midfoot deformity. METHODS: From July 2001 through July 2005, we performed reconstructive surgery on fifteen adults with diabetes mellitus who had a severe neuropathic midfoot deformity consisting of a collapsed plantar arch with a rocker-bottom foot deformity. Thirteen had a nonhealing midfoot plantar ulcer. All underwent realignment and arthrodesis with a medial column screw; some required additional fixation techniques depending on the extent of the deformity. Outcome measures included ulcer and surgical wound-healing, radiographic results, complications, and the need for amputation. RESULTS: The mean duration of clinical follow-up was forty-two months. Fourteen patients were able to walk, and there were no recurrent plantar ulcers. Thirteen patients were able to wear custom-made extra-depth, wide-toed shoes with molded inserts. One patient without prior ulceration had development of a deep infection that necessitated an amputation. Four feet had a nonunion, one of which was symptomatic requiring a revision to obtain union. CONCLUSIONS: Surgical reconstruction of a collapsed neuropathic foot deformity is technically demanding, but a successful outcome can result in a plantigrade foot that is free of ulceration and abnormal pressure points and a patient who is able to walk. The procedure described has an acceptable degree of complications although it has a high rate of nonunion. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/19339565/Realignment_and_extended_fusion_with_use_of_a_medial_column_screw_for_midfoot_deformities_secondary_to_diabetic_neuropathy_ L2 - https://doi.org/10.2106/JBJS.G.01396 DB - PRIME DP - Unbound Medicine ER -