What The Evidence Reveals About Midfoot Ulcers In Patients With Diabetes

Valerie Schade, DPM, AACFAS

   The podiatric physician should consider consults with wound care clinics, physical therapy, social work and rehabilitation or skilled nursing facilities during the postoperative recovery of these patients for optimal patient care.

   Dr. Schade is the Chief of the Limb Preservation Service and Director of the Complex Lower Extremity Surgery and Research Fellowship at Madigan Healthcare System in Tacoma, Wash. She is an Associate of the American College of Foot and Ankle Surgeons.

1. Wieman TJ, Griffiths GD, Polk HC Jr. Management of diabetic midfoot ulcers. Ann Surg. 1992; 215(6):627-30; discussion 630-2.
2. Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res. 1998; 349:116-31.
3. Laborde JM. Midfoot ulcers treated with gastrocnemius-soleus recession. Foot Ankle Int. 2009; 30(9):842-6.
4. Sticha RS, Frascone ST, Wertheimer SJ. Major arthrodeses in patients with neuropathic arthropathy. J Foot Ankle Surg. 1996; 35(6):560-6.
5. Pinzur M. Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int. 2004; 25(8):545-9.
6. Laurinaviciene R, Kirketerp-Moeller K, Holstein PE. Exostectomy for chronic midfoot plantar ulcer in Charcot deformity. J Wound Care. 2008; 17(2):53-8.
7. Pinzur MS, Sage R, Stuck R, Kaminsky S, Zmuda A. A treatment algorithm for neuropathic (Charcot) midfoot deformity. Foot Ankle. 1993; 14(4):189-97.
8. Brodsky JW, Rouse AM. Exostectomy for symptomatic bony prominences in diabetic charcot feet. Clin Orthop Relat Res. 1993; 296:21-6.
9. Rosenblum BI, Giurini JM, Miller LB, Chrzan JS, Habershaw GM. Neuropathic ulcerations plantar to the lateral column in patients with Charcot foot deformity: a flexible approach to limb salvage. J Foot Ankle Surg. 1997; 36(5):360-3.
10. Catanzariti AR, Mendicino R, Haverstock B. Ostectomy for diabetic neuroarthropathy involving the midfoot. J Foot Ankle Surg. 2000; 39(5):291-300.
11. Myerson MS, Henderson MR, Saxby T, Short KW. Management of midfoot diabetic neuroarthropathy. Foot Ankle Int. 1994; 15(5):233-41.
12. Sammarco VJ. Superconstructs in the treatment of charcot foot deformity: plantar plating, locked plating, and axial screw fixation. Foot Ankle Clin. 2009; 14(3):393-407.
13. Assal M, Stern R. Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. J Bone Joint Surg Am. 2009; 91(4):812-20.
14. Grant WP, Garcia-Lavin SE, Sabo RT, Tam HS, Jerlin E. A retrospective analysis of 50 consecutive Charcot diabetic salvage reconstructions. J Foot Ankle Surg. 2009; 48(1):30-8.
15. Grant WP, Garcia-Lavin S, Sabo R. Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis. J Foot Ankle Surg. 2011; 50(2):182-9.
16. Wiewiorski M, Yasui T, Miska M, Frigg A, Valderrabano V. Solid bolt fixation of the medial column in charcot midfoot arthropathy. J Foot Ankle Surg. 2013; 52(1):88-94.
17. Wiewiorski M, Valderrabano V. Intramedullary fixation of the medial column of the foot with a solid bolt in Charcot midfoot arthropathy: a case report. J Foot Ankle Surg. 2012; 51(3):379-81.
18. Cullen BD, Weinraub GM, Van Gompel G. Early results with use of the midfoot fusion bolt in charcot arthropathy. J Foot Ankle Surg. 2013; 52(2):235-8.
19. Early JS, Hansen ST. Surgical reconstruction of the diabetic foot: a salvage approach for midfoot collapse. Foot Ankle Int. 1996; 17(6):325-30.

   For further reading, see “How To Manage The Charcot Midfoot Deformity” in the July 2010 issue of Podiatry Today.

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