surgeon reports successful treatment for charcot's foot

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This article originally posted 21 July, 2010 and appeared in

Issue 531

Surgeon Reports Successful Treatment of Charcot Foot

Charcot foot can make walking difficult or impossible, and in severe cases

can require amputation but a newsurgical technique that secures foot bones

with

an external frame has enabled more than 90 percent of patients to walk

normally again....

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Loyola University Health System foot and ankle surgeon Dr. Pinzur,

Department of Orthopaedic Surgery and Rehabilitation at the Chicago Stritch

School

of Medicine, describes the procedure in a current publication.

The device, called a circular external fixator, is a rigid frame made of

stainless steel and aircraft-grade aluminum. It contains three rings that

surround

the foot and lower calf. The rings have stainless-steel pins that extend to

the foot and secure the bones after surgery.

The fixator " has been demonstrated to achieve a high potential for enhanced

clinical outcomes with a minimal risk for treatment-associated morbidity, "

Pinzur

wrote. Pinzur treats about 75 Charcot patients per year with external

fixators, most of whom are diabetics.

Charcot foot can occur in a diabetic who has neuropathy (nerve damage)

impairing the ability to feel pain. Charot foot typically occurs following a

minor

injury, such as a sprain or stress fracture. Because the patient doesn't

feel the injury, he or she continues to walk, making the injury worse. Bones

fracture,

joints collapse and the foot becomes deformed. The patient walks on the side

of the foot and develops pressure sores. Bones can become infected.

The obesity epidemic is increasing the incidence of Charcot foot in two

ways. The excess weight increases the risk of diabetic neuropathy, as well

as the

risk that patients with diabetic neuropathy will develop Charcot foot.

There has been an alarming increase in morbid obesity among diabetics. About

62 percent of U.S. adults with Type 2 diabetes now are obese, and 21 percent

are morbidly obese, according to a 2009 study by Loyola kidney specialist

Dr. Holly Kramer and colleagues published in the Journal of Diabetes and its

Complications.

Morbid obesity is defined as having a body mass index (BMI) greater than 40.

For example, a person who is 5-foot, 10-inches tall and has a BMI of 40

weighs

278 pounds.

Traditional surgical techniques, in which bones are held in place by

internal plates and screws, don't work with a subset of obese Charcot

patients. Their

bones, already weakened by complications of Charcot foot, could collapse

under the patient's heavy weight.

A common treatment in such cases is to put the patient in a cast. But bones

can heal in deformed positions. And, it is difficult or impossible for obese

patients to walk on one leg when the other leg is in a cast. Patients

typically have to use wheelchairs and are confined to the first story of the

house

for as long as nine months. And after the cast comes off, they must wear a

cumbersome leg brace.

By contrast, patients who are treated with an external fixator often are

able to walk or at least bear some weight on the treated leg. The device is

attached

to the leg for only two or three months.

A 2007 study by Pinzur, published in Foot & Ankle International,

demonstrated the benefits of the external fixator. Pinzur followed 26 obese,

diabetic Charcot

foot patients who had an average body mass index of 38.3. After surgery to

correct the deformity, the foot bones were held in place by the external

fixator.

A year or more later, 24 of the 26 patients (92 percent) had no ulcers or

bone infections and were able to walk without braces, wearing commercially

available

shoes designed for diabetics.

journal Hospital Practice, July 2010