• 1. 

    Berli M , Vlachopoulos L & Leupi S et al.: Treatment of Charcot neuroarthropathy and osteomyelitis of the same foot: a retrospective cohort study. BMC Musculoskelet Disord 18: 1, 2017.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2. 

    Güven MF , Karabiber A & Kaynak G et al.: Conservative and surgical treatment of the chronic Charcot foot and ankle. Diabet Foot Ankle 4: 1, 2013.

  • 3. 

    Dodd A & Daniels TR: Charcot neuroarthropathy of the foot and ankle. J Bone Joint Surg Am 100: 696, 2018.

  • 4. 

    Pakarinen T , Laine H & Maenpaa H et al.: Long-term outcome and quality of life in patients with Charcot foot. Foot Ankle Surg 15: 187, 2009.

  • 5. 

    Richman J , Cota A & Weinfeld S: Intramedullary nailing and external ring fixation for tibiotalocalcaneal arthrodesis in Charcot arthropathy. Foot Ankle Int 38: 149, 2017.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6. 

    Schneekloth BJ , Lowery NJ & Wukich DK: Charcot neuroarthropathy in patients with diabetes: an updated systematic review of surgical management level of evidence. J Foot Ankle Surg 55: 586, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7. 

    Ogut T & Yontar NS: Surgical treatment options for the diabetic Charcot hindfoot and ankle deformity. Clin Podiatr Med Surg 34: 53, 2017.

  • 8. 

    Wukich D , Sadoskas D & Vaudreuil N et al.: Comparison of diabetic Charcot patients with and without foot wounds. Foot Ankle Int 38: 140, 2017.

  • 9. 

    Young J: Foot shape and asymmetry in the Charcot foot: assessment using the Foot Posture Index. JAPMA 110: Article 4, 2020.

  • 10. 

    Rettedal D , Parker A & Popchak A et al.: Prognostic scoring system for patients undergoing reconstructive foot and ankle surgery for Charcot neuroarthropathy: the Charcot Reconstruction Preoperative Prognostic Score. J Foot Ankle Surg 57: 451, 2018.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11. 

    Blume PA , Sumpio B & Schmidt B et al.: Charcot neuroarthropathy of the foot and ankle: diagnosis and management strategies. Clin Pod Med Surg 31: 151, 2014.

  • 12. 

    Pinzur MS: Neutral ring fixation for high-risk nonplantigrade Charcot midfoot deformity. Foot Ankle Int 28: 961, 2007.

  • 13. 

    Kitaoka HB , Alexander IJ & Adelaar RS et al.: Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15: 349, 1994.

  • 14. 

    Ibrahim T , Beiri A & Azzabi M et al.: Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 46: 65, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15. 

    Varma A: Charcot neuroarthropathy of the foot and ankle: a review. J Foot Ankle Surg 52: 740, 2013.

  • 16. 

    Pinzur MS & Schiff AP: Deformity and clinical outcomes following operative correction of Charcot foot: a new classification with implications for treatment. Foot Ankle Int 39: 265, 2018.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17. 

    Kwaadu KY: Charcot reconstruction: understanding and treating the deformed Charcot neuropathic arthropathic foot. Clin Podiatr Med Surg 37: 247, 2020.

  • 18. 

    Raspovic KM , Liu GT & Lalli T et al.: Optimizing results in diabetic Charcot reconstruction. Clin Podiatr Med Surg 36: 469, 2019.

  • 19. 

    Stuck RM , Sohn MW & Budiman-Mak E et al.: Charcot arthropathy risk elevation in the obese diabetic population. Am J Med 121: 1008, 2008.

  • 20. 

    Wukich D , Lowery N & McMillen R et al.: Post-operative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. J Bone Joint Surg Am 92: 287, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21. 

    Finkler ES , Kasia C & Kroin E et al.: Pin tract infection following correction of charcot foot with static circular fixation. Foot Ankle Int 36: 1310, 2015.

  • 22. 

    Pinzur M , Freeland R & Juknelis D: The association between body mass index and foot disorders in diabetic patients. Foot Ankle Int 26: 375, 2005.

  • 23. 

    Lee BH , Fang C & Kunnasegaran R et al.: Tibiotalocalcaneal arthrodesis with the hindfoot arthrodesis nail: a prospective consecutive series from a single institution. J Foot Ankle Surg 57: 23, 2018.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24. 

    Alrashidi Y , Hügle T & Wiewiorski M et al.: Surgical treatment options for the diabetic Charcot midfoot deformity. Clin Podiatr Med Surg 34: 43, 2017.

  • 25. 

    Simon SR , Tejwani SG & Wilson DL et al.: Arthrodesis as an early alternative to nonoperative management of charcot arthropathy of the diabetic foot. J Bone Joint Surg Am 82-A: 939, 2000.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26. 

    Johnson J , Klein S & Brodsky J: “Diabetes,” in Surgery of Foot and Ankle, 9th Ed, edited by Coughlin, MJ, Saltzman, CL & Anderson, RB p 1385, Elsevier Inc, Philadelphia, 2014.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27. 

    Wukich D , Raspovic K & Hobizal K et al.: Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes. Diabetes Metab Res Rev 32: 292, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28. 

    Brandao RA , Weber JS & Larson D et al.: New fixation methods for the treatment of the diabetic foot: beaming, external fixation and beyond. Clin Podiatr Med Surg 35: 63, 2018.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29. 

    Safavi PS , Jupiter D & Panchbhavi V: A systematic review of current surgical interventions for Charcot neuroarthropathy of the midfoot. J Foot Ankle Surg 56: 1249, 2017.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30. 

    Saltzman CL , Hagy ML & Zimmerman B et al.: How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet? Clin Orthop Relat Res 435: 185, 2005.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31. 

    Zgonis T , Stapleton JJ & Roukis TS: A stepwise approach to the surgical management of severe diabetic foot infections. Foot Ankle Spec 1: 46, 2008.

  • 32. 

    Dalla Paola L , Carone A & Baglioni M et al.: Extension and grading of osteomyelitis are not related to limb salvage in Charcot neuropathic osteoarthropathy: a cohort prospective study. J Diabetes Complications 3: 608, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation

The Charcot Reconstruction Preoperative Prognostic Score's Evaluation with Complication Rate and Functional Outcome

Necip Selcuk Yontar
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Lercan Aslan
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Ata Can
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Tahir Ogut
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Background

Charcot's neuroarthropathy (CN) treatment is still controversial, and the results are controversial. Owing to patient comorbidities, surgical intervention carries a high risk of complications. Thus, foreseeing the possible results of planned treatment is crucial. We retrospectively evaluated the Charcot Reconstruction Preoperative Prognostic Score (CRPPS) in patients with surgically treated CN.

Methods

Twenty-two feet of 20 patients were included in the study. Two groups were formed according to their CRPPS. Twelve patients with values less than 4 were defined as group A, and eight patients with values of 4 or greater were defined as group B. Mean follow-up was 61 months (range, 5–131 months). Groups were compared according to American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Disability Index (FADI) scores, and complication rates.

Results

Group A and B mean AOFAS scores were 76.83 (range, 71–85) and 70.5 (range, 20–85), respectively. All of the patients were improved according to AOFAS and FADI scores, but no correlation was found with the CRPPS. None of the group A patients required additional intervention, but five patients in group B underwent revision surgery. No amputations were performed.

Conclusions

The CRPPS is focused on feasibility. The data needed to fill the scoring system is easily obtainable from medical records even retrospectively, and the score is helpful to predict a patient's outcome after CN-related surgery. Herein, CRPPS values of 4 or greater were related to high complication rates and lower functional outcomes.

Nisantasi Ortopedi Merkezi ayak-ayak bileği cerrahisi kliniği, Istanbul, Turkey.

Department of Orthopaedics and Traumatology, Koc University Hospital, Istanbul, Turkey.

Nisantasi Ortopedi Merkezi, Istanbul, Turkey.

Corresponding author: Lercan Aslan, MD, Koc University Hospital, Department of Orthopaedics and Traumatology, Davutpasa/Istanbul, Turkey. (E-mail: lercan.aslan86@gmail.com)

Conflict of Interest: None reported.

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