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Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy

Published in Journal of Bone and Joint Surgery. American Volume. 2009, vol. 91, no. 4, p. 812-820
Abstract BACKGROUND: The failure of nonsurgical treatment of patients with midfoot and hindfoot deformity secondary to diabetic Charcot arthropathy may lead to a rocker-bottom foot deformity with recurrent or persistent plantar ulceration. We report our experience with realignment and extended fusion with primary use of a medial column screw for this midfoot deformity. METHODS: From July 2001 through July 2005, we performed reconstructive surgery on fifteen adults with diabetes mellitus who had a severe neuropathic midfoot deformity consisting of a collapsed plantar arch with a rocker-bottom foot deformity. Thirteen had a nonhealing midfoot plantar ulcer. All underwent realignment and arthrodesis with a medial column screw; some required additional fixation techniques depending on the extent of the deformity. Outcome measures included ulcer and surgical wound-healing, radiographic results, complications, and the need for amputation. RESULTS: The mean duration of clinical follow-up was forty-two months. Fourteen patients were able to walk, and there were no recurrent plantar ulcers. Thirteen patients were able to wear custom-made extra-depth, wide-toed shoes with molded inserts. One patient without prior ulceration had development of a deep infection that necessitated an amputation. Four feet had a nonunion, one of which was symptomatic requiring a revision to obtain union. CONCLUSIONS: Surgical reconstruction of a collapsed neuropathic foot deformity is technically demanding, but a successful outcome can result in a plantigrade foot that is free of ulceration and abnormal pressure points and a patient who is able to walk. The procedure described has an acceptable degree of complications although it has a high rate of nonunion.
Keywords AdultAgedAnkle Joint/*surgery*Arthrodesis*Bone ScrewsDiabetic Foot/complicationsDiabetic Neuropathies/*complicationsFemaleFoot Bones/*surgeryFoot Deformities, Acquired/etiology/*surgeryHumansInternal FixatorsMaleMiddle AgedPostoperative ComplicationsRecurrenceWound Healing
PMID: 19339565
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ASSAL, Mathieu, STERN, Richard. Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. In: Journal of Bone and Joint Surgery. American Volume, 2009, vol. 91, n° 4, p. 812-820. doi: 10.2106/JBJS.G.01396 https://archive-ouverte.unige.ch/unige:19488

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Deposited on : 2012-04-23

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