Comparison of orthopaedic reconstruction of diabetic Charcot foot Eichenholtz stages 1-2 and conservative treatment

Abstract

The objective was to evaluate the efficacy and safety of closed transosseous osteosynthesis in the treatment of patients with diabetic Charcot neuroosteoarthropathy at the acute radiographically positive stage (Eichenholtz 1-2) with hindfoot and midfoot deformity and immobilization using Total Contact Cast. Material and methods Eight patients of the treatment group underwent closed deformity correction and Ilizarov external fixation. The frame was removed with radiographic signs of consolidation and conservative methods of fixation and off-loading employed. The control group consisted of 11 patients who received outpatient conservative treatment with Total Contact Cast combined with crutches. Results The treatment length of surgical patients prior to the use of orthopaedic shoes was shorter than that of patients treated conservatively. Foot ulcers seen in the conservative group during the observation period were not detected in the surgical cases and were associated with the lack of deformity correction. Discussion The advantage of operative reconstruction includes more stable foot and lower risk of ulcers. Reduced rehabilitation period improves the patient's quality of life. Complications that developed in the treatment group were resolved and had no effect on the outcome. Conclusion Closed deformity correction using transosseous osteosynthesis can be an option for patients with diabetic Charcot neuroosteoarthropathy at the acute radiographically positive stage as compared to the conservative treatment.

Keywords

• diabetic foot syndrome
• charcot foot
• arthrodesis
• transosseous osteosynthesis
• ilizarov apparatus
• immobilization