Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes

Dane K. Wukich, Katherine M. Raspovic, Kimberlee B. Hobizal, David Sadoskas

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)292-296
Number of pages5
JournalDiabetes/Metabolism Research and Reviews
Volume32
DOIs
StatePublished - Jan 1 2016

Fingerprint

Ankle
Foot
Talus
Ulcer
Extremities
Tobacco Use Cessation
Calcaneus
Limb Salvage
Vitamin D Deficiency
Arthrodesis
Osteomyelitis
Tibia
Biomechanical Phenomena
Blood Vessels
Necrosis
Outcome Assessment (Health Care)
Pressure
Bone and Bones
Pain
Infection

Keywords

  • Ankle
  • Charcot
  • Diabetes
  • Hindfoot
  • Reconstruction
  • Surgery

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes. / Wukich, Dane K.; Raspovic, Katherine M.; Hobizal, Kimberlee B.; Sadoskas, David.

In: Diabetes/Metabolism Research and Reviews, Vol. 32, 01.01.2016, p. 292-296.

Research output: Contribution to journalArticle

@article{ec2da9f765f240df99bc9bf33a0b97f8,
title = "Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes",
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.",
keywords = "Ankle, Charcot, Diabetes, Hindfoot, Reconstruction, Surgery",
author = "Wukich, {Dane K.} and Raspovic, {Katherine M.} and Hobizal, {Kimberlee B.} and David Sadoskas",
year = "2016",
month = "1",
day = "1",
doi = "10.1002/dmrr.2748",
language = "English (US)",
volume = "32",
pages = "292--296",
journal = "Diabetes/Metabolism Research and Reviews",
issn = "1520-7552",
publisher = "John Wiley and Sons Ltd",

}

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 - 2016/1/1

Y1 - 2016/1/1

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.

AB - 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.

KW - Ankle

KW - Charcot

KW - Diabetes

KW - Hindfoot

KW - Reconstruction

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84956728053&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84956728053&partnerID=8YFLogxK

U2 - 10.1002/dmrr.2748

DO - 10.1002/dmrr.2748

M3 - Article

C2 - 26452590

AN - SCOPUS:84956728053

VL - 32

SP - 292

EP - 296

JO - Diabetes/Metabolism Research and Reviews

JF - Diabetes/Metabolism Research and Reviews

SN - 1520-7552

ER -