Can A New Ex-Fix Device Have An Impact In Deformity Correction?

By Amy L. Duckworth, DPM

   Complications related to obesity have been a topic of concern for health officials since the 1950s. However, it has only been in the past few years that a widespread epidemic has reached alarming proportions in the United States and worldwide, leading to substantial health and economic costs. In the U.S., obesity is largely linked to an increase in the incidence of type II diabetes mellitus and metabolic syndrome.    In fact, a recently published study by the Centers for Disease Control and Prevention (CDC) warns that “one-third of Americans born in 2000 could develop diabetes.”1 Accordingly, managing associated complications from this disease is an essential priority for those of us who see patients with diabetes on a regular basis.    There is an array of lower extremity complications secondary to diabetes. These complications include peripheral vascular disease, peripheral neuropathy and biomechanical deformities resulting from motor-sensory neuropathy.    The most notable deformities arise from Charcot neuroarthropathy. Charcot destruction does not occur in the absence of peripheral neuropathy and approximately 30 to 50 percent of patients with diabetes have peripheral neuropathy.2-6 Unfortunately, there is a significant discrepancy in the literature when it comes to the incidence of Charcot in patients with diabetes as the incidence ranges from 0.2 to 29 percent.2,5-10    While Charcot represents one end of the spectrum of diabetic foot deformities, longstanding, motorsensory neuropathy secondary to diabetes represents the other end of the spectrum. On average, a majority of the mild to moderate foot deformities are amenable to accommodative shoe gear, conservative management and/or bracing. Historically, surgery was indicated in a diabetic patient only if he or she had a deep space infection with or without osteomyelitis, when accommodative methods failed or at the patient’s request.4,11

A Closer Look At Surgery For Lower-Extremity Diabetic Deformities

   However, the concept of surgical correction for the diabetic foot and ankle deformity has resurfaced in the past few years.    Pinzur collected data over a 10-year period on treating Charcot arthropathy of the foot and ankle. According to the data, 48.5 percent of patients were treated with conservative therapy while 50.6 percent of patients underwent surgery. The surgical procedures included 21 major limb amputations, 29 ankle fusions, 26 hindfoot fusions, 23 exostectomies and 23 debridements for osteomyelitis.4 Conservative management of Charcot deformities (stage I or stage II), in the form of total contact casts, bracing devices and/or accommodative footgear, is approximately 75 percent effective.5,12    Surgical reconstruction of a moderate to severe foot and/or ankle deformity secondary to diabetes has come to the limelight as a potential salvage procedure for preventing further deformity and subsequent tissue breakdown, infection and ultimately amputation.9,11,13-16 Myerson and Edwards found that surgical correction resulted in lower-extremity stabilization in 93 percent of patients who presented with severe deformity.5

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