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Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes.
Diabetes Metab Res Rev. 2016 Jan; 32 Suppl 1:292-6.DM

Abstract

BACKGROUND

Charcot neuroarthropathy (CN) of the ankle and hindfoot (Sanders/Frykberg Type IV) is challenging to treat surgically or nonsurgically. The deformities associated with ankle/hindfoot CN are often multiplanar, resulting in sagittal, frontal and rotational malalignment. In addition, shortening of the limb often occurs from collapse of the distal tibia, talus and calcaneus. These deformities also result in significant alterations in the biomechanics of the foot. For example, a varus ankle/hindfoot results in increased lateral column plantar pressure of the foot, predisposing the patient to lateral foot ulceration. Collapse of the talus, secondary to avascular necrosis or neuropathic fracture, further accentuates these deformities and contributes to a limb-length inequality.

SURGICAL MANAGEMENT

The primary indication for surgical reconstruction is a nonbraceable deformity associated with instability. Other indications include impending ulceration, inability to heal an ulcer, recurrent ulcers, presence of osteomyelitis and/or significant pain. Arthrodesis of the ankle and/or hindfoot is the method of choice when surgically correcting CN deformities in this region. The choice of fixation (i.e. internal or external fixation) depends on largely on the presence or absence of active infection and bone quality.

CONCLUSION

Surgical reconstruction of ankle and hindfoot CN is associated with a high rate of infectious and noninfectious complications. Despite this high complication rate, surgeons embarking on surgical reconstruction of ankle and hindfoot CN should strive for limb salvage rates approximating 90%. Preoperative measures that can improve outcomes include assessment of vascular status, optimization of glycemic control, correction of vitamin D deficiency and cessation of tobacco use.

Authors+Show Affiliations

Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, WA, USA.Podiatric Surgery Program, Heritage Valley, Beaver, PA, USA.Fellow Reconstruction and Limb Salvage Surgery UPMC Mercy Hospital, Pittsburgh, PA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26452590

Citation

Wukich, Dane K., et al. "Surgical Management of Charcot Neuroarthropathy of the Ankle and Hindfoot in Patients With Diabetes." Diabetes/metabolism Research and Reviews, vol. 32 Suppl 1, 2016, pp. 292-6.
Wukich DK, Raspovic KM, Hobizal KB, et al. Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes. Diabetes Metab Res Rev. 2016;32 Suppl 1:292-6.
Wukich, D. K., Raspovic, K. M., Hobizal, K. B., & Sadoskas, D. (2016). Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes. Diabetes/metabolism Research and Reviews, 32 Suppl 1, 292-6. https://doi.org/10.1002/dmrr.2748
Wukich DK, et al. Surgical Management of Charcot Neuroarthropathy of the Ankle and Hindfoot in Patients With Diabetes. Diabetes Metab Res Rev. 2016;32 Suppl 1:292-6. PubMed PMID: 26452590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes. AU - Wukich,Dane K, AU - Raspovic,Katherine M, AU - Hobizal,Kimberlee B, AU - Sadoskas,David, PY - 2015/05/01/received PY - 2015/07/06/revised PY - 2015/10/06/accepted PY - 2015/10/11/entrez PY - 2015/10/11/pubmed PY - 2016/10/26/medline KW - Charcot KW - ankle KW - diabetes KW - hindfoot KW - reconstruction KW - surgery SP - 292 EP - 6 JF - Diabetes/metabolism research and reviews JO - Diabetes Metab Res Rev VL - 32 Suppl 1 N2 - BACKGROUND: Charcot neuroarthropathy (CN) of the ankle and hindfoot (Sanders/Frykberg Type IV) is challenging to treat surgically or nonsurgically. The deformities associated with ankle/hindfoot CN are often multiplanar, resulting in sagittal, frontal and rotational malalignment. In addition, shortening of the limb often occurs from collapse of the distal tibia, talus and calcaneus. These deformities also result in significant alterations in the biomechanics of the foot. For example, a varus ankle/hindfoot results in increased lateral column plantar pressure of the foot, predisposing the patient to lateral foot ulceration. Collapse of the talus, secondary to avascular necrosis or neuropathic fracture, further accentuates these deformities and contributes to a limb-length inequality. SURGICAL MANAGEMENT: The primary indication for surgical reconstruction is a nonbraceable deformity associated with instability. Other indications include impending ulceration, inability to heal an ulcer, recurrent ulcers, presence of osteomyelitis and/or significant pain. Arthrodesis of the ankle and/or hindfoot is the method of choice when surgically correcting CN deformities in this region. The choice of fixation (i.e. internal or external fixation) depends on largely on the presence or absence of active infection and bone quality. CONCLUSION: Surgical reconstruction of ankle and hindfoot CN is associated with a high rate of infectious and noninfectious complications. Despite this high complication rate, surgeons embarking on surgical reconstruction of ankle and hindfoot CN should strive for limb salvage rates approximating 90%. Preoperative measures that can improve outcomes include assessment of vascular status, optimization of glycemic control, correction of vitamin D deficiency and cessation of tobacco use. SN - 1520-7560 UR - https://www.unboundmedicine.com/medline/citation/26452590/Surgical_management_of_Charcot_neuroarthropathy_of_the_ankle_and_hindfoot_in_patients_with_diabetes_ L2 - https://doi.org/10.1002/dmrr.2748 DB - PRIME DP - Unbound Medicine ER -