Skip to main content
SpringerLink
Log in

Plate Fixation Techniques for Midfoot and Forefoot Charcot Arthropathy

  • Chapter
  • First Online:
The Surgical Management of the Diabetic Foot and Ankle

  • 1337 Accesses

Abstract

Charcot arthropathy of the midfoot and forefoot remains one of the most devastating complications of diabetes mellitus, resulting in significant deformity and disability of the foot and ankle. In severe cases, a rocker-bottom foot develops leading to recurrent plantar ulcerations, with the possibility of developing an infection and osteomyelitis. When nonoperative treatment is ineffective, surgical management is warranted to correct the instability and deformity by creating a shoeable, plantigrade foot. The use of plates is an effective way to achieve stability in patients with Charcot arthropathy. Important surgical considerations involve an anatomic reduction versus wedge resection realignment, the location of plate placement, as well as a fusion of the lateral fourth and fifth metatarsocuboid joints. Major complications associated with the use of plate fixation in midfoot and forefoot include ulcerations, infections, hardware failure, and recurrence or progression of deformity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Reiber GE, Lipsky BA, Gibbons GW. The burden of diabetic foot ulcers. Am J Surg. 1998;176:5S–10.

    Article  CAS  PubMed  Google Scholar 

  2. Simon SR, Tejwani SG, Wilson DL, Santner TJ, Denniston NL. Arthrodesis as an early alternative to nonoperative management of Charcot arthropathy of the diabetic foot. J Bone Joint Surg Am. 2000;82A:939–50.

    Google Scholar 

  3. Johnson JE, Klein SE, Brodsky JW. Diabetes. In: Coughlin MJ, Saltzman CL, Anderson RB, editors. Surgery of the foot and ankle. St. Louis, MO: Mosby; 2013. p. 1385–480.

    Google Scholar 

  4. Armstrong DG, Lavery LA. Elevated peak plantar pressures in patients who have Charcot arthropathy. J Bone Joint Surg Am. 1998;80A:365–9.

    Google Scholar 

  5. Myerson MS, Henderson MR, Saxby T, Short KW. Management of midfoot diabetic neuroarthropathy. Foot Ankle Int. 1994;15:233–41.

    Article  CAS  PubMed  Google Scholar 

  6. Saltzman CL, Hagy ML, Zimmerman B, Estin M, Cooper R. How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet? Clin Orthop Relat Res. 2005;435:185–90.

    Article  PubMed  Google Scholar 

  7. Eichenholtz S. Charcot joints. Springfield, Ill: Charles C Thomas; 1966.

    Google Scholar 

  8. Lowery NJ, Woods JB, Armstrong DG, Wukich DK. Surgical management of Charcot neuroarthropathy of the foot and ankle: a systematic review. Foot Ankle Int. 2012;33:113–21.

    Article  PubMed  Google Scholar 

  9. Brodsky JW. The diabetic foot. In: Mann RA, Coughlin MJ, editors. Surgery of the foot and ankle. St Louis, MO: Mosby; 1999. p. 1385–480.

    Google Scholar 

  10. Trepman E, Nihal A, Pinzur MS. Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int. 2005;26(1):46–63.

    PubMed  Google Scholar 

  11. Schon LC, Easley ME, Cohen I, Lam PW, Badekas A, Anderson CD. The acquired midtarsus deformity classification system, interobserver reliability and intraobserver reproducibility. Foot Ankle Int. 2002;23(1):30–6.

    PubMed  Google Scholar 

  12. Schon LC, Weinfeld SB, Horton GA, Resch S. Radiographic and clinical classification of acquired midtarsus deformities. Foot Ankle Int. 1998;19:394–404.

    Article  CAS  PubMed  Google Scholar 

  13. Wukick DK, Sung W. Charcot arthropathy of the foot and ankle: modern concepts and management review. J Diabetes Complications. 2009;23:409–26.

    Article  Google Scholar 

  14. Burns PR, Wukich DK. Surgical reconstruction of the Charcot rearfoot and ankle. Clin Podiatr Med Surg. 2008;25:95–120.

    Article  PubMed  Google Scholar 

  15. Garapati R, Weinfeld SB. Complex reconstruction of the diabetic foot and ankle. Am J Surg. 2004;187:81–6.

    Article  Google Scholar 

  16. Early JS, Hansen ST. Surgical reconstruction of the diabetic foot: a salvage approach for midfoot collapse. Foot Ankle Int. 1996;17:325–30.

    Article  CAS  PubMed  Google Scholar 

  17. Sammarco GJ, Conti SF. Surgical treatment of neuroarthropathic foot deformity. Foot Ankle Int. 1998;19:102–9.

    Article  CAS  PubMed  Google Scholar 

  18. Tisdel CL, Marcus RE, Heiple KG. Triple arthrodesis for diabetic peritalar neuroarthropathy. Foot Ankle Int. 1995;16:332–8.

    Article  CAS  PubMed  Google Scholar 

  19. Bono JV, Roger DJ, Jacobs RL. Surgical arthrodesis of the neuropathic foot: a salvage procedure. Clin Orthop Relat Res. 1993;296:14–20.

    PubMed  Google Scholar 

  20. Marks RM, Parks BG, Schon LC. Midfoot fusion technique for neuropathic feet: biomechanical analysis and rationale. Foot Ankle Int. 1998;19:507–10.

    Article  CAS  PubMed  Google Scholar 

  21. Papa J, Myerson M, Girard P. Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle. J Bone Joint Surg. 1993;75-A:1056–66.

    Google Scholar 

  22. Pinzur MS, Sage R, Stuck R, Kaminsky S, Zmuda A. A treatment algorithm for neuropathic (Charcot) midfoot deformity. Foot Ankle Int. 1993;14:189–97.

    Article  CAS  Google Scholar 

  23. Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clin Orthop. 1998;349:116–31.

    Article  PubMed  Google Scholar 

  24. Sammarco VJ. Superconstructs in the treatment of Charcot foot deformity: plantar plating, locked plating, and axial screw fixation. Foot Ankle Clin. 2009;14:393–407.

    Article  PubMed  Google Scholar 

  25. Cohen DA, Parks BG, Schon LC. Screw fixation compared to H-locking plate fixation for first metatarsocuneiform arthrodesis: a biomechanical study. Foot Ankle Int. 2005;26:984–9.

    PubMed  Google Scholar 

  26. Gruber F, Sinkov VS, Bae SY, Parks BG, Schon LC. Crossed screws versus dorsomedial locking plate with compression screw for first metatarsocuneiform arthrodesis: a cadaver study. Foot Ankle Int. 2008;29(9):927–30.

    Article  PubMed  Google Scholar 

  27. Horton GA, Olney BW. Deformity correction and arthrodesis of the midfoot with a medial plate. Foot Ankle. 1993;14:493–9.

    Article  CAS  PubMed  Google Scholar 

  28. Zonno AJ, Myerson MS. Surgical correction of midfoot arthritis with and without deformity. Foot Ankle Clin. 2011;16(1):35–47.

    Article  PubMed  Google Scholar 

  29. Schon LC, Bell W. Fusions of the transverse tarsal and midtarsal joints. Foot Ankle Clin. 1996;1:93–108.

    Google Scholar 

  30. Ouzounian TJ, Shereff MJ. In vitro determination of midfoot motion. Foot Ankle. 1989;10:140–6.

    Article  CAS  PubMed  Google Scholar 

  31. Komenda GA, Myerson MS, Biddinger KR. Results of arthrodesis of the tarsometatarsal joints after traumatic injury. J Bone Joint Surg Am. 1996;78(11):1665–76.

    CAS  PubMed  Google Scholar 

  32. Raikin SM, Schon LC. Arthrodesis of the fourth and fifth tarsometatarsal joints of the midfoot. Foot Ankle Int. 2003;24(8):584–90.

    PubMed  Google Scholar 

  33. Lau JT, Stamatis ED, Myerson MS, Schon LC. Implantable direct-current bone stimulators in high-risk and revision foot and ankle surgery: a retrospective analysis with outcome assessment. Am J Orthop (Belle Mead NJ). 2007;36(7):354–7.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 3333 N. Calvert St., JPB 400, Baltimore, MD, 21218, USA

    Eric W. Tan M.D. & Lew C. Schon M.D.

Authors
  1. Eric W. Tan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lew C. Schon M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lew C. Schon M.D. .

Editor information

Editors and Affiliations

  1. Foot and Ankle/Trauma Service, Tampa General Hospital, Tampa, Florida, USA

    Dolfi Herscovici, Jr.

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Tan, E.W., Schon, L.C. (2016). Plate Fixation Techniques for Midfoot and Forefoot Charcot Arthropathy. In: Herscovici, Jr., D. (eds) The Surgical Management of the Diabetic Foot and Ankle. Springer, Cham. https://doi.org/10.1007/978-3-319-27623-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27623-6_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27621-2

  • Online ISBN: 978-3-319-27623-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation