Diabetic Deformities of the Lesser Toes.

The United States Centers for Disease Control and the National Institute of Diabetic, Digestive and Kidney Disorders now estimates that there are now over 34.2 million patients with diabetes in the United Sates, or over 10.2% of our population.

Painful Nonunion in Patients With Clinically Plantigrade Diabetes-Associated Charcot Foot Arthropathy.

Background: It has been assumed that diabetic patients with peripheral neuropathy should not have pain associated with Charcot foot arthropathy.

Methods: During a 19-year period, 14 diabetic patients (15 feet) presented for treatment with pain following resolution of the acute phases of midfoot Charcot foot arthropathy. All were clinically plantigrade with plain radiographic evidence of bony union without deformity.

Outcomes Following Surgical Correction of Talocalcalcaneal Joint Dislocation in Diabetes Associated Charcot Foot Arthropathy.

Background: Growing clinical interest in the treatment of acquired foot deformity due to diabetes-associated Charcot foot arthropathy has led to multiple reports of favorable clinical outcomes in patients when their acquired deformity is at the midfoot level. Clinical failures and less than optimal clinical outcomes are achieved when the deformity is at the hindfoot or ankle levels.

Methods: A retrospective review was performed of all patients who underwent surgical correction of diabetes-associated Charcot foot arthropathy with talocalcaneal dislocation over an 18-year period.

Preliminary Experience With Commercially Available Trabecular Metal Tibial Cones Combined With a Retrograde Locked Intramedullary Nail for Bony Defects in Tibiotalocalcaneal Arthrodesis.

Critical sized bone defects in the ankle are becoming increasingly more common in patients undergoing limb reconstruction with tibiotalocalcaneal arthrodesis. Bulk allografts have not fared well over time. There have been scattered preliminary reports using custom spinal cages or 3D-printed Titanium Implants to address the critical bony defect; however, the cost of these devices is prohibitive in many clinical practice settings.

Management of Infections and Osteomyelitis in Patients With Charcot Foot Arthropathy.

There is growing interest in performing reconstruction of deformities associated with Charcot foot arthropathy. At least half of the patients undergoing this reconstruction will have chronic wounds and osteomyelitis overlying the deformity. It is important to provide orthopaedic surgeons with tools for making the diagnosis of osteomyelitis in this patient population and creating a strategy for treatment.

Management of Acute Ankle Fractures in Patients With Diabetes.

Ankle fractures in patients with diabetes can be difficult to manage, especially when patients present with hyperglycemia. Treatment often requires a combination of both medical and surgical care, especially in patients with poorly controlled diabetes. The goal of any treatment is to obtain a well-aligned ankle fracture that heals without any further displacement and to avoid the development of a Charcot joint.

Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty.

Tranexamic acid has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty. The purpose of this study was to determine whether tranexamic acid use in patients with total ankle arthroplasty affects blood loss or overall complication rate.

The Modern Treatment of Charcot Foot Arthropathy.

The National Institute of Health now estimates that there are well over 37 million persons with diabetes in the United States alone, a number well over 11 per cent of our population. The associated multiple organ system disease is responsible for more than 327 billion dollars in direct and indirect medical costs and more than 140,000 lower extremity amputations yearly in the United States. Because healthcare professionals have begun to appreciate the economic and pathologic burden that diabetes imparts on our society, there has been a growth in both the understanding and treatment of the responsible pathologic disorders.

Unstable Ankle Fractures in Neuropathic Diabetics.

Connolly recognized as early as 1998 that a displaced ankle fracture in a neuropathic diabetic puts that patient at risk for an amputation. It is well appreciated that the risk of a poor clinical outcome secondary to failure of the surgical construct, deep wound infection and osteomyelitis or a combination of both, is greatly increased in neuropathic diabetic patients, that is, those that are insensate to the Semmes-Weinstein 5.07 (10 g) monofilament, as compared with sensate diabetics or similar non-diabetic patients.

Quality of Life Improvement Following Reconstruction of Midtarsal Charcot Foot Deformity: A Five Year Follow-Up.

Background: There is increasing interest in reconstruction of diabetes-associated Charcot foot arthropathy with the goal of improving quality of life.

Methods: Twenty-four patients who completed the Short Musculoskeletal Function Assessment (SMFA) at baseline and one year following Charcot foot reconstruction were contacted and asked to complete the survey at five years following surgery.

Results: Fourteen of the 24 patients completed the SMFA preoperatively, one year following surgery and five years postoperatively.

Risk Reduction and Perioperative Complications in Patients With Diabetes and Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction.

Background: Modern patient safety programs focus on medical optimization of patients prior to surgery, regional anesthesia when possible, and hospitalist-orthopedic co-management during the perioperative period.

Methods: Eighty-five consecutive patients with diabetes and multiple medical comorbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized risk reduction program that included medical optimization prior to surgery, regional anesthesia whenever possible, and hospitalist-orthopedic co-management during the perioperative period.

Treatment of Ankle and Hindfoot Charcot Arthropathy.

It is now well accepted that diabetic patients with clinically and radiographically nonplantigrade Charcot foot arthropathy are best managed with correction of the acquired deformity. Several investigations have demonstrated a high probability for a favorable clinical outcome when the deformity is in the midfoot. Unstable deformity at the subtalar or ankle joints portends a far worse clinical outcome.

Risk of Complications With the Total Contact Cast in Diabetic Foot Disorders.

The custom-fabricated total contact cast is commonly used in the treatment of diabetic foot disorders. This resource-consuming treatment option has been associated with iatrogenic morbidity as well as the need for urgent cast removal and inspection of the underlying limb when potential problems arise. Over a 10-year period, 381 diabetic patients had 2265 total contact cast applications by certified orthopaedic technologists, in a university orthopaedic practice, under the supervision of university faculty.