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. Surgical technique.
J Bone Joint Surg Am. 2010 Mar; 92 Suppl 1 Pt 1:20-31.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

Service de Chirurgie Orthopédique et Traumatologiede l'Appareil Moteur, Hôpitaux Universitaires de Genève, 24 rue Micheli-du-Crest, Genève 14, Switzerland.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20194341

Citation

Assal, Mathieu, et al. "Realignment and Extended Fusion With Use of a Medial Column Screw for Midfoot Deformities Secondary to Diabetic Neuropathy. Surgical Technique." The Journal of Bone and Joint Surgery. American Volume, vol. 92 Suppl 1 Pt 1, 2010, pp. 20-31.
Assal M, Ray A, Stern R. Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique. J Bone Joint Surg Am. 2010;92 Suppl 1 Pt 1:20-31.
Assal, M., Ray, A., & Stern, R. (2010). Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique. The Journal of Bone and Joint Surgery. American Volume, 92 Suppl 1 Pt 1, 20-31. https://doi.org/10.2106/JBJS.I.01288
Assal M, Ray A, Stern R. Realignment and Extended Fusion With Use of a Medial Column Screw for Midfoot Deformities Secondary to Diabetic Neuropathy. Surgical Technique. J Bone Joint Surg Am. 2010;92 Suppl 1 Pt 1:20-31. PubMed PMID: 20194341.
* 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. Surgical technique. AU - Assal,Mathieu, AU - Ray,Adrien, AU - Stern,Richard, PY - 2010/3/3/entrez PY - 2010/3/18/pubmed PY - 2010/4/2/medline SP - 20 EP - 31 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 92 Suppl 1 Pt 1 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/20194341/Realignment_and_extended_fusion_with_use_of_a_medial_column_screw_for_midfoot_deformities_secondary_to_diabetic_neuropathy__Surgical_technique_ L2 - https://doi.org/10.2106/JBJS.I.01288 DB - PRIME DP - Unbound Medicine ER -