When Charcot Reconstructions Fail

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Author(s): 
William P. Grant, DPM, FACFAS, Bryan Barbato, BS, Lisa Grant, BS

   When a Charcot reconstruction failure develops, one must consider amputation. Before making this decision, one needs to consider factors including the patient’s potential to be a community ambulator, his or her adherence to recommended treatment and, most especially, the viability of the opposite limb.

Final Words

It has been the senior author’s experience that in many instances, the salvaged Charcot limb eventually becomes the patient’s only limb when diabetic complications result in contralateral amputation. One needs to recognize that Charcot reconstruction does nothing to reverse the metabolic damage that created the Charcot foot just as bypass and endovascular surgeries do nothing to reverse the patients’ indicated pathology. It should be our goal as surgeons to try to restore function, and provide the patient with an opportunity to ambulate for as long as he or she reasonably can.

   We should not delude ourselves with the idea that we are curing anything with these surgeries. However, repair of the Charcot foot can be worthwhile with years of improved ambulation and the quality of life that the freedom of bipedal gait provides our patients.

   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.

   Ms. Grant is a fourth-year podiatric medical student at the College of Podiatric Medicine and Surgery at Des Moines Medical University.

   Mr. Barbato is a graduate of James Madison University and a current applicant to colleges of podiatric medicine.

References

1. Stapleton J, Belczyk R, Zgonis T. Revisional Charcot foot and ankle surgery. Clinics Podiatr Med. 2009; 26(1):127-39.
2. Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. 2006; 45(5):1-66.
3. Shapiro SA, Stansberry KB, Hill MA, Meyer MD, McNitt PM, Bhatt BA, Vinik AI. Normal blood flow response and vasomotion in the diabetic Charcot foot. J Diabetes Complications. 1998; 12(3):147-53
4. Palena LM, Brocco E, Manzi M. Critical limb ischemia in association with Charcot neuroarthropathy: complex endovascular therapy for limb salvage. Cardiovasc Intervent Radiol. 2013; (Epub ahead of print)
5. Palena LM, Brocco E, Ninkovic S, Volpe A, Manzi M. Ischemic Charcot foot: different disease with different treatment? J Cardiovasc Surg (Torino). 2013;54(5):561-6
6. Grant WP, Rubin LG, Pupp GR, Vito G, Jacobus D, Jerlin E, Tam HS. Mechanical testing of seven fixation methods for generation of compression across a midtarsal osteotomy: a comparison of internal nd external fixation devices. J Foot Ankle Surg. 2007; 46(5):325-35.
7. Cooper PS. Application of external fixators for management of Charcot deformities of the foot and ankle. Foot Ankle Clin. 2002; 7(1):207–254.
8. Pinzur MS, Gil J, Belmares J. Treatment of osteomyelitis in Charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation. Foot Ankle Int. 2012; 33(12):1069-74.

   Editor’s note: For further reading, see “Limb Salvage And The Charcot Foot: What The Evidence Shows” in the March 2011 issue of Podiatry Today, “Emerging Concepts In Fixation For Charcot Midfoot Reconstruction” in the February 2011 issue or “Current Concepts With External Fixation And The Charcot Foot” in the October 2013 issue.

   For an enhanced online experience, check out Podiatry Today on your iPad or Android tablet.

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