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Preliminary Results of Primary Gastrocnemius-Soleus Recession for Midfoot Charcot Arthropathy.
Foot Ankle Spec. 2016 Apr; 9(2):140-4.FA

Abstract

Background Treatment of Charcot arthopathy of the foot can be challenging. The goal of this investigation was to determine whether primary gastrocnemius-soleus recession could decrease rate of new ulcers, progression of deformity, and amputation in patients with Charcot arthropathy of the midfoot.Methods A retrospective chart review revealed 28 feet in 24 diabetic patients with radiographic evidence of Charcot arthropathy of the midfoot. They were treated with primary gastrocnemius-soleus recession. Eleven feet in 11 patients had concurrent plantar midfoot ulcers. Three feet in 3 patients were lost to follow-up. Twenty-five feet in 21 patients were followed for an average of 37 months postoperatively (range = 18-79).Results A favorable outcome was defined as healing of existing ulcers, no new ulcers, no obvious progression of deformity, and no amputation. Favorable outcomes were obtained in 22 of 25 feet (18 of 21 patients). Only one patient had a persistent ulcer after gastrocnemius-soleus recession. The other 10 patients with preexisting ulcers healed. Deformity of midfoot progressed in one patient, leading ultimately to transtibial amputation. Another patient developed a knee joint infection and had a transfemoral amputation at another institution.Discussion These preliminary data suggest that primary gastrocnemius-soleus recession is followed by a much lower rate of persistent, recurrent, and new ulceration than previously reported studies. Gastrocnemius-soleus recession seems to aid in the treatment of Charcot arthropathy of the midfoot.

LEVELS OF EVIDENCE

Level IV.

Authors+Show Affiliations

Touro Infirmary, New Orleans, Louisiana (JML)Westerville Medical Campus, Westerville, Ohio (TMP, JD)Beaumont Army Medical Center, El Paso, Texas (PJC) monroe@laborde.net.Touro Infirmary, New Orleans, Louisiana (JML)Westerville Medical Campus, Westerville, Ohio (TMP, JD)Beaumont Army Medical Center, El Paso, Texas (PJC).Touro Infirmary, New Orleans, Louisiana (JML)Westerville Medical Campus, Westerville, Ohio (TMP, JD)Beaumont Army Medical Center, El Paso, Texas (PJC).Touro Infirmary, New Orleans, Louisiana (JML)Westerville Medical Campus, Westerville, Ohio (TMP, JD)Beaumont Army Medical Center, El Paso, Texas (PJC).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26395022

Citation

Laborde, J Monroe, et al. "Preliminary Results of Primary Gastrocnemius-Soleus Recession for Midfoot Charcot Arthropathy." Foot & Ankle Specialist, vol. 9, no. 2, 2016, pp. 140-4.
Laborde JM, Philbin TM, Chandler PJ, et al. Preliminary Results of Primary Gastrocnemius-Soleus Recession for Midfoot Charcot Arthropathy. Foot Ankle Spec. 2016;9(2):140-4.
Laborde, J. M., Philbin, T. M., Chandler, P. J., & Daigre, J. (2016). Preliminary Results of Primary Gastrocnemius-Soleus Recession for Midfoot Charcot Arthropathy. Foot & Ankle Specialist, 9(2), 140-4. https://doi.org/10.1177/1938640015607051
Laborde JM, et al. Preliminary Results of Primary Gastrocnemius-Soleus Recession for Midfoot Charcot Arthropathy. Foot Ankle Spec. 2016;9(2):140-4. PubMed PMID: 26395022.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preliminary Results of Primary Gastrocnemius-Soleus Recession for Midfoot Charcot Arthropathy. AU - Laborde,J Monroe, AU - Philbin,Terrence M, AU - Chandler,Philip J, AU - Daigre,Justin, Y1 - 2015/09/22/ PY - 2015/9/24/entrez PY - 2015/9/24/pubmed PY - 2017/1/18/medline KW - Charcot KW - gastrocnemius recession SP - 140 EP - 4 JF - Foot & ankle specialist JO - Foot Ankle Spec VL - 9 IS - 2 N2 - UNLABELLED: Background Treatment of Charcot arthopathy of the foot can be challenging. The goal of this investigation was to determine whether primary gastrocnemius-soleus recession could decrease rate of new ulcers, progression of deformity, and amputation in patients with Charcot arthropathy of the midfoot.Methods A retrospective chart review revealed 28 feet in 24 diabetic patients with radiographic evidence of Charcot arthropathy of the midfoot. They were treated with primary gastrocnemius-soleus recession. Eleven feet in 11 patients had concurrent plantar midfoot ulcers. Three feet in 3 patients were lost to follow-up. Twenty-five feet in 21 patients were followed for an average of 37 months postoperatively (range = 18-79).Results A favorable outcome was defined as healing of existing ulcers, no new ulcers, no obvious progression of deformity, and no amputation. Favorable outcomes were obtained in 22 of 25 feet (18 of 21 patients). Only one patient had a persistent ulcer after gastrocnemius-soleus recession. The other 10 patients with preexisting ulcers healed. Deformity of midfoot progressed in one patient, leading ultimately to transtibial amputation. Another patient developed a knee joint infection and had a transfemoral amputation at another institution.Discussion These preliminary data suggest that primary gastrocnemius-soleus recession is followed by a much lower rate of persistent, recurrent, and new ulceration than previously reported studies. Gastrocnemius-soleus recession seems to aid in the treatment of Charcot arthropathy of the midfoot. LEVELS OF EVIDENCE: Level IV. SN - 1938-7636 UR - https://www.unboundmedicine.com/medline/citation/26395022/Preliminary_Results_of_Primary_Gastrocnemius_Soleus_Recession_for_Midfoot_Charcot_Arthropathy_ L2 - https://journals.sagepub.com/doi/10.1177/1938640015607051?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -