Radiographic analysis of diabetic midfoot charcot neuroarthropathy with and without midfoot ulceration

Dane K. Wukich, Katherine M. Raspovic, Kimberlee B. Hobizal, Bedda Rosario

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: The aim of this study was to evaluate weight-bearing radiographs in patients with and without foot ulcers diagnosed with midfoot Charcot neuroarthropathy (CN) secondary to diabetes mellitus.

Methods: One hundred fourteen patients with midfoot CN (50 with foot ulcers and 64 without ulcers) were identified and included in this study. Nine radiographic measurements were made (7 in the sagittal plane and 2 in the transverse plane).

Results: CN patients with foot ulcers had significantly greater deformity when assessing the lateral-talar first metatarsal angle, calcaneal pitch, cuboid height, medial column height, calcaneal-fifth metatarsal angle, talar declination, and lateral tibiotalar angle. Two measurements in the transverse plane (hindfoot-forefoot angle and AP talar first metatarsal angle) were not significantly different between the 2 groups. Of patients with foot ulcers, 24% had a lateral talar first metatarsal angle of less than -27 degrees and 80% had a negative cuboid height.

Conclusion: Sagittal plane deformities were more likely to be associated with foot ulceration in patients with CN than transverse plane deformities. Lateral column involvement was associated with a worse prognosis than medial column involvement, thus we believe progressive deformity of the lateral column should be monitored closely to prevent foot ulceration. Lateral column involvement could be identified by a decrease in the cuboid height, decreased calcaneal pitch, and decreased lateral calcaneal fifth metatarsal angle. This study can assist physicians in stratifying the risk for both ulceration and need for surgery in patients with CN based on reproducible radiographic measurements. Level of Evidence: Level III, comparative series.

Original languageEnglish (US)
Pages (from-to)1108-1115
Number of pages8
JournalFoot and Ankle International
Volume35
Issue number11
DOIs
StatePublished - Jan 1 2014

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Metatarsal Bones
Foot Ulcer
Foot
Weight-Bearing
Ulcer
Diabetes Mellitus
Physicians

Keywords

  • Charcot neuroarthropathy
  • deformity
  • diabetes
  • ulcers

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Radiographic analysis of diabetic midfoot charcot neuroarthropathy with and without midfoot ulceration. / Wukich, Dane K.; Raspovic, Katherine M.; Hobizal, Kimberlee B.; Rosario, Bedda.

In: Foot and Ankle International, Vol. 35, No. 11, 01.01.2014, p. 1108-1115.

Research output: Contribution to journalArticle

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