A Closer Look At Beaming The Columns In The Charcot Diabetic Foot
- Volume 27 - Issue 3 - March 2014
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If beaming a subtalar implant or fusion of the subtalar joint appropriate for the reconstruction, do this prior to the placement of the medial and lateral beams.
Since the senior author first began using beaming procedures in 1994, the demographics of the population have significantly changed with regard to obesity. This epidemic directly correlates with the increase in diabetes and patients with Charcot neuroarthropathy. Currently manufactured orthopedic screws may provide a reasonable 2x safety factor for bending moments through the hindfoot in patients weighing 150 lbs. This is not the case for patients who exceed 300 and sometimes 400 lbs. In this population group, beam failure directly associated with the design of the current commercially available large diameter cannulated screws is a clinical concern as one can see in the radiographic images above at left. We see it as a challenge to solve this problem.
Patients with diabetes and peripheral neuropathy are predisposed to have Charcot neuroarthropathy. Damaged nerve conduction pathways from altered glucose tolerance can be a viable source for inducing Charcot neuroarthropathy due to a lack of balance and proprioception resulting in damaged bone, which stimulates osteoclastic activity.2
As surgeons, our challenge is to find solutions that address the pathologies at hand. Beaming is uniquely appropriate for Charcot neuroarthropathy in that it directly addresses issues of increased bone density, decreased bone stiffness and ligament failure with a time proven basic engineering solution. Refinement of this concept is necessary as the population of our patients with this disease become more obese.
Dr. Grant is a Fellow of the American College of Foot and Ankle Surgeons, and is board-certified by the American Board of Podiatric Surgery. He is an instructor in the Department of Surgery at Eastern Virginia Medical School and is in private practice in Virginia Beach, Va.
Mr. Barbato is a graduate of James Madison University and a current applicant to colleges of podiatric medicine.
Mrs. Grant-McDonald is a fourth-year podiatric medical student at Des Moines University.