UNIGE document Scientific Article
previous document  unige:20749  next document
add to browser collection

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

Published in The Journal of bone and joint surgery. American volume. 2010, vol. 92 Suppl 1 Pt 1, p. 20-31
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 Arthrodesis/ methodsBone ScrewsBone TransplantationDiabetic Foot/complications/radiography/ surgeryFoot Deformities, Acquired/etiology/ surgeryHumansPostoperative CareRetrospective StudiesTransplantation, AutologousTreatment OutcomeWeight-Bearing
PMID: 20194341
Full text
Article - document accessible for UNIGE members only Limited access to UNIGE
Other version: http://www.jbjs.org/index.php
(ISO format)
ASSAL, Mathieu, RAY, Adrien, STERN, Richard. Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique. In: Journal of Bone and Joint Surgery. American Volume, 2010, vol. 92 Suppl 1 Pt 1, p. 20-31. doi: 10.2106/JBJS.I.01288 https://archive-ouverte.unige.ch/unige:20749

487 hits

1 download


Deposited on : 2012-05-23

Export document
Format :
Citation style :