Charcot Foot, a Rare and Severe Complication of Diabetes Mellitus

Charcot foot or Charcot neuropathy is a rare disease found in patients with diabetes mellitus and is characterized by bone damage to the foot leading to deformities, instability, functional impotence and even amputation. The mechanism is still under discussion, without a consensus regarding the pathophysiology of this condition. The treatment is a complex one, non-surgical and surgical, the non-surgical one addressing especially the acute phase of the disease, the surgical one being complex and ranging from osteotomy, debridement, arthrodesis, internal or external fixation or even amputation. A good management of diabetes, of its peripheral complications, an early recognition of the Charcot type foot, prevents the evolution towards this serious condition.

Prognostic risk factors for complications associated with Tibiotalocalcaneal fusion with a nail

Category: Ankle Introduction/Purpose: Tibiotalocalcaneal (TTC) fusion with a nail is an effective salvage procedure for several foot and ankle pathologies, but it is associated with a relatively high complication rate and often performed on patients with multiple medical comorbidities. There is a paucity of literature that aids in predicting outcomes for patients undergoing TTC fusion with a nail. Methods: Clinical and radiographic outcomes for 82 patients from 2012-2016 who underwent TTC fusion with intramedullary nailing were retrospectively evaluated. Postoperative complications of nonunion, infection, reoperation, and hardware failure were included for comparison. Patient dependent variables and surgeon dependent variables were evaluated for association with these postoperative complications. Results: The overall complication rate for TTC fusion with a nail was 47/82 (57.3%). Diabetes (p=.049), diabetic neuropathy (p=.031), ASA classification (p=.005), and Charcot neuropathy (p=.003) were associated with nonunion of either the tibiotalar or subtalar joints in 29/82 (35.3%) patients. Diabetic neuropathy was associated with need for reoperation (p=.016) in 21/82 (25.6%) patients. Diabetic neuropathy (p=.022) and HbA1C >7.5 (p=.047) was associated with hardware failure in 13/82 (15.9%) patients. The odds ratio (OR) for diabetic neuropathy was 2.99 (p=0.038) for nonunion in the tibiotalar or subtalar joints, 3.46 (p=0.021) for re-operation, and 4.11 (p=0.035) for hardware failure. High ASA classification had an odds ratio of 3.93 (p=0.006) for nonunion in the tibiotalar or subtalar joints. Conclusion: Patients with diabetic neuropathy, Charcot neuropathy, elevated HbA1C, and higher ASA classification demonstrated a higher complication rate in patients undergoing TTC fusion with a nail.

Intra-Articular Giant Heterotopic Ossification following Total Knee Arthroplasty for Charcot Arthropathy

Although the Charcot arthropathy may be associated with serious complications, total knee arthroplasty (TKA) is the preferred choice of treatment by patients. This case report presents an 80-year-old man with intra-articular giant heterotopic ossification following loosening of femoral and tibial implants and femoral condylar fracture. He had undergone TKA because of Charcot neuropathy seven years ago and had been doing well since. Immediately after a left knee sprain, he became unable to walk. Because he had developed a skin ulcer on his left calf where methicillin-resistantStaphylococcus aureuswas detected, we postponed revision surgery until the ulcer was completely healed. While waiting, intra-articular bony fragments grew larger and formed giant heterotopic ossified masses. Eventually, the patient underwent revision surgery, and two major ossified masses were carefully and successfully extirpated. It should be noted that intra-articular heterotopic giant ossification is a significant complication after TKA for neuropathic arthropathy.

Cellulitis or Charcot Neuropathy in Diabetes

Cellulitis of the lower limb is a common presentation in patients with diabetes. We report a case illustrating how Charcot neuropathy can be overlooked because of its resemblance to cellulitis.