Beaming the Columns for Charcot Diabetic Foot Reconstruction: A Retrospective Analysis

• Published in: The Journal of foot and ankle surgery Vol. 50; no. 2; pp. 182 - 189
• Main Authors: Grant, William P., DPM, FACFAS, Garcia-Lavin, Silvia, DPM, Sabo, Roy, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01.03.2011
• Subjects: Adult; Aged; Arthrodesis; Arthropathy, Neurogenic - diagnostic imaging; Arthropathy, Neurogenic - etiology; Arthropathy, Neurogenic - surgery; Associated diseases and complications; Biological and medical sciences; Bone Screws; Diabetes. Impaired glucose tolerance; Diabetic Foot - complications; Diabetic Foot - surgery; Diseases of the osteoarticular system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Foot Bones - surgery; Foot Deformities, Acquired - diagnostic imaging; Foot Deformities, Acquired - etiology; Foot Deformities, Acquired - surgery; Humans; Male; Medical sciences; Middle Aged; Orthopedic Procedures; Orthopedic surgery; Orthopedics; Radiography; Retrospective Studies; Subtalar Joint - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; 2; complication; arthrodesis; fixation; neuropathy; bone; foot; surgery; Endocrinopathy; Skin disease; Nervous system diseases; Diabetic Foot; Diabetes mellitus; Anatomical reconstruction; Neuropathy; Fixation; Treatment; Surgery; Orthopedics; Disease of the foot; Arthrodesis; Complication; Bone
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2010.12.002

Abstract This study explored the concept of “beaming” the medial and lateral longitudinal columns as a variation of the current technique for hindfoot and Lisfranc Charcot reconstruction. We reviewed radiographic changes and outcomes for patients who underwent Charcot foot reconstruction at our facility over the 14-year period from January 1994 to January 2008. Beaming was performed on 71 Charcot foot deformities in 70 patients, 22 (31%) of which displayed an isolated hindfoot deformity, 20 (28%) an isolated Lisfranc deformity, and 29 (41%) with a combination of hindfoot and Lisfranc deformities. The average radiographic follow up was 31.00 ± 22.97 months. Group 1 consisted of reconstructions that involved only medial and lateral column beams and showed significant improvements in radiographic alignment between the preoperative and postoperative measurements, including Meary’s angle ( P < .001), calcaneal inclination angle ( P = .004), tarsometatarsal angle ( P = .002), talonavicular angle ( P = .035), and the calcaneocuboid angle ( P = .006). Group 2, which consisted of reconstructions that involved medial and lateral column beams and either a subtalar arthroereisis (n = 18) or a subtalar joint fusion (n = 10), also showed significant improvements, including Meary’s angle ( P < .001), tarsometatarsal angle ( P < .001), talonavicular angle ( P = .002), and the calcaneocuboid angle ( P < .001), although calcaneal inclination did not statistically significantly change ( P = .054). In both groups, the surgical intervention maintained the correction and was useful for Charcot reconstruction. Complications included pin tract infections, broken pin, osteomyelitis, transfer lesions, and ulcerations.