Tags

Type your tag names separated by a space and hit enter

Should one consider primary surgical reconstruction in charcot arthropathy of the feet?
Clin Orthop Relat Res. 2010 Apr; 468(4):1002-11.CO

Abstract

Charcot neuroosteoarthropathy of the feet can induce severe instability and deformity with subsequent plantar ulceration leading to substantial disability or even amputation. Traditionally, nonoperative treatment is regarded as the primary option of treatment while surgery is restricted to treating complications or failure of nonoperative treatment. Failed nonoperative treatment essentially prolongs treatment period. We retrospectively reviewed 22 patients (26 feet) with midfoot (n = 9) or hindfoot (n = 17) neuropathy who underwent primary surgical reconstruction and reorientation arthrodesis due to manifest instability, nonplantigrade foot position, and deformity with overt (n = 8) or what we judged was impending ulceration (n = 9). The minimum followup was 0.5 years (mean, 2.7 years; range 0.5-7 years). All eight ulcers healed without recurrence of ulceration or manifestation of new ulcers during the followup period. We observed complications leading to further surgery in nine patients: five with perioperative hematoma and four with instability. AOFAS scores rose from a preoperative mean of 39 to 70 points (hindfoot cases) and from 51 points to 84 (midfoot cases). Early surgical reconstruction in high-risk patients can provide timely restoration of a plantigrade and stable foot and improved quality of life of the patient at complication rates comparable to those after secondary surgery following failed nonoperative treatment; however we emphasize we had no control group in this small case series for which we could compare nonoperative treatment.

LEVEL OF EVIDENCE

Level IV, therapeutic study (case series). See Guidelines for Authors for a complete description of levels of evidence.

Authors+Show Affiliations

Chirurgische Klinik und Poliklinik der Universität Rostock, Abteilung für Unfall- und Wiederherstellungschirurgie, Schillingallee 35, 18055, Rostock, Germany. thomas.mittlmeier@med.uni-rostock.deNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19597899

Citation

Mittlmeier, Thomas, et al. "Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?" Clinical Orthopaedics and Related Research, vol. 468, no. 4, 2010, pp. 1002-11.
Mittlmeier T, Klaue K, Haar P, et al. Should one consider primary surgical reconstruction in charcot arthropathy of the feet? Clin Orthop Relat Res. 2010;468(4):1002-11.
Mittlmeier, T., Klaue, K., Haar, P., & Beck, M. (2010). Should one consider primary surgical reconstruction in charcot arthropathy of the feet? Clinical Orthopaedics and Related Research, 468(4), 1002-11. https://doi.org/10.1007/s11999-009-0972-x
Mittlmeier T, et al. Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet. Clin Orthop Relat Res. 2010;468(4):1002-11. PubMed PMID: 19597899.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should one consider primary surgical reconstruction in charcot arthropathy of the feet? AU - Mittlmeier,Thomas, AU - Klaue,K, AU - Haar,Patrick, AU - Beck,Markus, Y1 - 2009/07/14/ PY - 2008/12/01/received PY - 2009/06/23/accepted PY - 2009/7/15/entrez PY - 2009/7/15/pubmed PY - 2010/4/7/medline SP - 1002 EP - 11 JF - Clinical orthopaedics and related research JO - Clin Orthop Relat Res VL - 468 IS - 4 N2 - UNLABELLED: Charcot neuroosteoarthropathy of the feet can induce severe instability and deformity with subsequent plantar ulceration leading to substantial disability or even amputation. Traditionally, nonoperative treatment is regarded as the primary option of treatment while surgery is restricted to treating complications or failure of nonoperative treatment. Failed nonoperative treatment essentially prolongs treatment period. We retrospectively reviewed 22 patients (26 feet) with midfoot (n = 9) or hindfoot (n = 17) neuropathy who underwent primary surgical reconstruction and reorientation arthrodesis due to manifest instability, nonplantigrade foot position, and deformity with overt (n = 8) or what we judged was impending ulceration (n = 9). The minimum followup was 0.5 years (mean, 2.7 years; range 0.5-7 years). All eight ulcers healed without recurrence of ulceration or manifestation of new ulcers during the followup period. We observed complications leading to further surgery in nine patients: five with perioperative hematoma and four with instability. AOFAS scores rose from a preoperative mean of 39 to 70 points (hindfoot cases) and from 51 points to 84 (midfoot cases). Early surgical reconstruction in high-risk patients can provide timely restoration of a plantigrade and stable foot and improved quality of life of the patient at complication rates comparable to those after secondary surgery following failed nonoperative treatment; however we emphasize we had no control group in this small case series for which we could compare nonoperative treatment. LEVEL OF EVIDENCE: Level IV, therapeutic study (case series). See Guidelines for Authors for a complete description of levels of evidence. SN - 1528-1132 UR - https://www.unboundmedicine.com/medline/citation/19597899/Should_one_consider_primary_surgical_reconstruction_in_charcot_arthropathy_of_the_feet L2 - https://link.springer.com/article/10.1007/s11999-009-0972-x DB - PRIME DP - Unbound Medicine ER -