TY - JOUR T1 - Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy JF - Canadian Journal of Surgery JO - CAN J SURG SP - 449 LP - 455 VL - 43 IS - 6 AU - N. Craig Stone AU - Timothy R. Daniels Y1 - 2000/12/01 UR - http://canjsurg.ca/content/43/6/449.abstract N2 - Objectives: To review the clinical outcome of arthrodesis of the foot in patients with diabetic Charcot arthropathy and to review the pathophysiology, clinical and radiographic features of Charcot arthropathy.Design: A retrospective review and clinical follow-up of a series of patients.Setting: St. Michael’s Hospital, Toronto, a tertiary care teaching hospital.Patients: Ten diabetic patients treated between 1996 and 1998 who required an arthrodesis of the midfoot or hindfoot secondary to deformity of diabetic neuropathic joints.Interventions: Three midfoot (Lisfranc) and 7 hindfoot arthrodeses with autogenous iliac-crest bone grafting and internal fixation.Outcome measures: Patient satisfaction, maintenance of the correction of the deformity and avoidance of amputation. Western Ontario/McMaster University score and midfoot/hindfoot American Orthopaedic Foot and Ankle Society foot ratios. Clinical examination including E-MED pedographic examination. Correction and evidence of bony or fibrous union assessed radiologically.Results: The postoperative correction was maintained, no further skin ulceration occurred and amputation was avoided in 9 of 10 patients. Because this is a salvage procedure and there was often significant concomitant illness, the results of clinical rating systems were poor. Five of 9 patients had clinical and radiographic evidence of a solid bony arthrodesis; 4 had a stable fibrous union.Conclusions: With careful surgical technique, a reasonable number of feet can be salvaged by an arthrodesis of a diabetic neuropathic joint when nonoperative measures fail. Patient selection is important because there is a significant complication rate. ER -