Midfoot Charcot and Need for Arch Reconstruction and Superconstruct—“Lessons Learnt”: Multicentric Indian Experience
Aims and background: Charcot’s neuroarthropathy (CN) affecting the midfoot leads to fractures and dislocation of the tarsal bones and displaced predominantly to the plantar aspect of the foot. Further, loading on these bony prominences leads to midfoot ulcers. Hence, corrective fusion of the involve...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Jaypee Brothers Medical Publisher
2023-10-01
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| Series: | Journal of Foot and Ankle Surgery (Asia Pacific) |
| Subjects: | |
| Online Access: | https://www.jfasap.com/doi/JFASAP/pdf/10.5005/jp-journals-10040-1324 |
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| Summary: | Aims and background: Charcot’s neuroarthropathy (CN) affecting the midfoot leads to fractures and dislocation of the tarsal bones and displaced predominantly to the plantar aspect of the foot. Further, loading on these bony prominences leads to midfoot ulcers. Hence, corrective fusion of the involved medial and/or lateral columns is necessary to protect the foot from ulcers and recurrent infections. Our primary objective was to assess the radiological and functional outcomes of midfoot fusion in CN. A secondary aim was to estimate the incidence of complications such as loss of fixation, implant fracture, and wound dehiscence following the procedure.
Materials and methods: This is a retrospective study of all patients operated in three different centers by four different surgeons, between 2018 and 2022. All patients who were diagnosed with Charcot’s arthropathy of the midfoot were included in the study. Patients with hindfoot Charcot’s arthropathy, arthritis due to posttraumatic, inflammatory, and infective sequelae were excluded. Data (radiological and functional) of all patients in the three orthopedic centers were collected. Functional outcomes were assessed using the midfoot—American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome Score (FAOS) scoring system preoperatively and at the final follow-up. Radiological assessment was done for union and the lateral talometatarsal (TMT) (Meary’s) angle, talo-first metatarsal angle in antero-posterior (AP) view, calcaneal pitch, and cuboid height were utilized for assessing the foot reconstruction in sagittal and axial planes.
Results: We had a total of 98 patients (center-1—55), (center-2—15), and (center-3—28) with a mean follow-up ranging from 10 ± 2 to 79 ± 12 months. There was significant improvement in midfoot AOFAS scores and FAOS postoperatively across the centers; however, it was statistically significant in center-1 (<italic>p</italic>-value = 0.0005) and center-2 (<italic>p</italic>-value = 0.042). Stable union (bony/fibrous) ranged between 78.5 and 95%. Meary’s angle improved in all centers, and it was statistically significant in center-1 (<italic>p</italic>-value = 0.0005), talar-1st MT angle in AP view, and cuboid height improved significantly in center-1 and 2 (<italic>p</italic>-value = 0.0005) while calcaneal pitch showed statistically significant improvement center-1 (<italic>p</italic>-value = 0.042), and center-3 (<italic>p</italic>-value = 0.0005). The total complication rate ranged between 46% and 51% [minor (6–23%), major (25–40%)] with screw breakage at the TMT junction being the most common complication encountered. The reoperation rate ranged from 0 to 27% across the centers. Only one patient needed amputation due to recurrent infection.
Conclusion: Based on the observations in this study, we would recommend early surgical intervention in midfoot CN. Medial and lateral column fusion with intramedullary beam screws with or without superconstruct results in an acceptable bony union/fibrous union that provides a plantigrade stable foot despite complications like implant breakage, loss of fixation, and wound infections. |
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| ISSN: | 2348-280X 2394-7705 |