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Study finds high success rate for diabetic Charcot foot surgery

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A new study shows a high success rate for surgery to correct Charcot foot, a type of bone deformity that can affect the feet of people with diabetes.

Orthopaedic surgeons Dr Michael Pinzur and Dr Adam Schiff at Loyola Medicine in Illinois found that nearly four out of five patients with severe cases of Charcot foot, also known as Charcot arthropathy, were able to walk normally again following surgery.

The condition can occur in diabetics who have nerve damage (neuropathy) which impairs their ability to feel foot pain and may also affect their sense of balance. It usually develops following a minor injury, such as a sprain or stress fracture, Loyola Medicine explains. Because the patient doesn’t feel the injury, he or she continues to walk, making the injury worse.

While most patients can be treated successfully by immobilising the foot, a small percentage develop severe deformities or bone infections.

“Charcot foot is a debilitating condition that is very challenging to treat,” Dr Pinzur said. “But with the proper surgical treatment, most patients will be able to walk normally again.”

The retrospective study included 214 Charcot foot patients who underwent reconstruction of the acquired deformity over a 12-year period — including nine patients who had operations on both feet.

Overall, 173 of the 223 feet (77.6%) had good or excellent outcomes, the researchers found. They defined an excellent outcome as being free of ulcers and infections and able to walk outside the home using off-the-shelf therapeutic footwear and custom foot braces. A good outcome was defined as being infection- and ulcer-free and able to walk outside the home with either a custom shoe modification and/or a short ankle-foot brace.

Success rates for the surgery varied according to the type of Charcot foot deformity. Patients with a valgus deformity pattern were most likely to achieve a favourable clinical outcome (87%). The success rate was 70.3% among patients with a dislocation pattern deformity and 56.3% with a varus deformity pattern.

The findings have been published in Foot & Ankle International, the official journal of the American Orthopaedic Foot & Ankle Society.