Realignment and Extended Fusion with Use of a Medial Column Screw for Midfoot Deformities Secondary to Diabetic Neuropathy

Assal, Mathieu; Ray, Adrien; Stern, Richard
March 2010
Journal of Bone & Joint Surgery, American Volume;Mar2010 Supplement 1, Vol. 92-A, p20
Academic Journal
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. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Foot soldiers in the war on diabetes.  // Patient Care;1/15/1996, Vol. 30 Issue 1, p11 

    Reports on the benefits of a filament with a single nylon fiber attached to a Lucite handle in preventing diabetes-related amputations in the United States. Dangers of diabetic neuropathy; Features of the filament; Features of the Lower Extremity Amputation Prevention (LEAP) program promoting...

  • Gu�a cl�nica basada en evidencia para el manejo del pie diab�tico. Castro, Guadalupe; Liceaga, Gabriela; Arrioja, Araceli; Calleja, Juan Manuel; Espejel, Alejandro; Flores, Jos�; Garc�a, Teresa; Hern�ndez, Sergio; Gavito, Eduardo L�pez; de Jes�s, Ferm�n Mart�nez; Nettel, Francisco Jacobo; Ra�l Romero Cabello; Rosas, Juan; Wacher, Niels H.; Cote, Lilia; Guzm�n, Rosa Mar�a; Bladinieres, Eduardo; M�rquez, Gustavo; Alvarez, Edgar R. // Medicina Interna de Mexico;nov/dic2009, Vol. 25 Issue 6, p481 

    Background:infections and ulcers in the foot of diabetic patients are commonplace, complex and costly. Furthermore, they are the primary cause of non-traumatic lower extremity amputation. The management of this complication must be multidisciplinary, timely and effective in order to reduce the...

  • The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy. Tung-Liang Lin; Huey-Min Sheen; Chin-Teng Chung; Sai-Wei Yang; Shih-Yi Lin; Hong-Ji Luo; Chung-Yu Chen; I-Cheng Chan; Hsu-Sheng Shih; Wayne Huey-Herng Sheu // Journal of Foot & Ankle Research;2013, Vol. 6 Issue 1, p1 

    Background: Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions,...

  • Plantar Stresses on the Neuropathic Foot During Barefoot Walking. Mueller, Michael J; Zou, Dequan; Bohnert, Kathryn L; Tuttle, Lori J; Sinacore, David R // Physical Therapy;Nov2008, Vol. 88 Issue 11, p1375 

    Background and Purpose: Patients with diabetes mellitus and peripheral neuropathy are at high risk for plantar skin breakdown due to unnoticed plantar stresses during walking. The purpose of this study was to determine differences in stress variables (peak plantar pressure, peak pressure...

  • Microsurgery Procedure Can Save Feet.  // USA Today Magazine;Feb2000, Vol. 128 Issue 2657, p14 

    Reports that microsurgical procedures in the United States on diabetic patients suffering extreme nerve damage and facing amputation in one foot can prevent amputation in both feet. Development of peripheral neuropathy in diabetics; Characteristics of people with diabetes.

  • The virtuoso foot. Morton, Jennie // Clinical Rheumatology;Apr2013, Vol. 32 Issue 4, p439 

    The foot and ankle are prone to injury in the performing arts population, not least amongst dancers who require extreme ranges of movement in this area. This is a complex anatomical area which can be vulnerable to wide array of injuries. Many of these injuries stem from the dancer's posture,...

  • Diabetic Charcot Neuroarthropathy of the Hand: Clinical Course, Diagnosis, and Treatment Options. Illgner, Ulrich; van Netten, Jaap; Droste, Carolin; Meiners, Thomas; Postema, Klaas; Wetz, Hans H. // Diabetes Care;May2014, Vol. 37 Issue 5, pe91 

    The article discusses the clinical course, diagnosis and treatment options for four patients with diabetic Charcot neuroarthropathy (CN) of the hand. Information is presented on the cases of the patients, who had swelling, loss of strength, and severe paresthesia of the hand. The authors...

  • Understanding the Mechanism of Plantar Fascitis. Lee, Kirk // American Chiropractor;Mar2012, Vol. 34 Issue 3, p22 

    The article focuses on the aspects of the plantar fascitis. It states that plantar fasciitis is an ailment that is common for runners but anyone can develop it. It says that the first signs and symptoms of plantar fasciitis are usually foot pain with walking difficulty when arising from the bed...

  • Comprehensive Foot Examination and Risk Assessment. Boulton, Andrew J. M.; Armstrong, David G.; Albert, Stephen F.; Frykberg, Robert G.; Hellman, Richard; Kirkman, M. Sue; Lavery, Lawrence A.; Lemaster, Joseph W.; Mills Sr., Joseph L.; Mueller, Michael J.; Sheehan, Peter; Wukich, Dane K. // Diabetes Care;Aug2008, Vol. 31 Issue 8, p1679 

    The article suggests various methods of foot examination and risk assessment for foot ulceration or amputation based on the report of the American Diabetes Association's Task Force of the Foot Care Interest Group. Dermatological assessment includes a global inspection of the foot for the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics