DIABETIC CHARCOT FOOT AND ANKLE
Approximately 1,530,000 people are diagnosed with diabetes in the United States each year.1 Diabetics face serious complications to the foot and ankle including nerve damage and poor circulation that can weaken the bones, resulting in conditions such as Charcot neuroarthroapathy (Charcot Foot and Charcot Ankle). Out of the 29 million people suffering from diabetes, around 0.08-0.13% develop Charcot Foot or Charcot Ankle.2 This painless, progressive, inflammatory, destructive degenerative disease can cause severe deformity, joint dislocations, and fractures. As the disease progresses, a fracture-dislocation through the tarsal metatarsal joint complex can occur leading to a collapse of the longitudinal arch of the foot, creating what is known as a rocker bottom foot deformity.3
WHY DYNANAIL IS THE ULTIMATE LIMB SALVAGE SURGERY OPTION
As the deformity worsens and ulcers develop, amputation is commonly the end result in the treatment continuum. However, the mortality rates following amputation have been shown to be as high as 62% at one year, 50% at two years, and 29% at five years.4 Hindfoot fusion is often performed as a limb salvage surgery in attempt to preserve the patient’s limb and correct the deformity. However, patients with diabetic Charcot foot or Charcot ankle are considered at significant risk of non-union due to their inherent poor bone quality and healing capacity.5 with reported fusion rates of 71-84%,6,7 for diabetics and ranging from 33-84% for Charcot patients.8,9 These low fusion rates underscore the importance of maintaining compression to ensure stability and promote healing in an effort to salvage the patient’s limb.
The DynaNail TTC Fusion System has demonstrated success in treating high-risk patients such as those with diabetic Charcot Foot through its ability to maintain compression and stabilize the joints following hindfoot fusion surgery.10, 11, 12
Case example of a 58-year-old diabetic male with neuropathy up to the ankle
Courtesy of Naohiro Shibuya, DPM (Temple, TX)
ORIF caused osteolysis (Charcot process)
2Sundararajan, S. R., Srikanth, K. P., Nagaraja, H. S., & Rajasekaran, S. (2017). Effectiveness of Hindfoot Arthrodesis by Stable Internal Fixation in Various Eichenholtz Stages of Neuropathic Ankle Arthropathy. The Journal of Foot and Ankle Surgery, 56(2), 282-286. doi:10.1053/j.jfas.2016.11.002.
3Wiewiorski, M., et al., Solid bolt fixation of the medial column in Charcot midfoot arthropathy. J Foot Ankle Surg, 2013. 52(1): p. 88-94.
4Ploeg AJ, Lardenoye JW, Vrancken Peeters MP, Breslau PJ. Contemporary Series of Morbidity and Mortality After Lower Limb Amputation. Eur J Vasc Endovasc Surg 2005;29(6):633-637.
5Shibuya N. The Charcot Foot. Complications in Foot and Ankle Surgery. 2017:329-355. doi:10.1007/978-3-319-53686-6_24.
6Richman, J., Cota, A., & Weinfeld, S. (2016). Intramedullary Nailing and External Ring Fixation for Tibiotalocalcaneal Arthrodesis in Charcot Arthropathy. Foot & Ankle International, 38(2), 149-152. doi:10.1177/1071100716671884.
7Wukich, D. K., Mallory, B. R., Suder, N. C., & Rosario, B. L. (2015). Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nail Fixation: Comparison of Patients With and Without Diabetes Mellitus. The Journal of Foot and Ankle Surgery, 54(5), 876-882. doi:10.1053/j.jfas.2015.02.019.
8Rammelt, S., Pyrc, J., Ågren, P., Hartsock, L. A., Cronier, P., Friscia, D. A., . . . Sands, A. K. (2013). Tibiotalocalcaneal Fusion Using the Hindfoot Arthrodesis Nail. Foot & Ankle International, 34(9), 1245-1255. doi:10.1177/1071100713487526.
9Jeng, C. L., Campbell, J. T., Tang, E. Y., Cerrato, R. A., & Myerson, M. S. (2013). Tibiotalocalcaneal Arthrodesis with Bulk Femoral Head Allograft for Salvage of Large Defects in the Ankle. Foot & Ankle International, 34(9), 1256-1266. doi:10.1177/1071100713488765.
10Ford, S., MD, & Ellington, J. K., MD, MS. (2017). Tibiotalocalcaneal Arthrodesis
Utilizing a Titanium Intramedullary Nail with an Internal Pseudoelastic Nitinol Compression Element. Foot & Ankle Orthopaedics, 2(3). doi:10.1177/2473011417s000171.
11Goss, K. A., D.P.M. (2017). The Charcot Ankle – A Novel Classification and Treatment Algorithm. Phoenix, AZ: 2017 Desert Foot & Ankle Conference.
12Kreulen, C., MD, MS, Lian, E., BS, & Giza, E., MD. (2016). Technique for Use of Trabecular Metal Spacers in Tibiotalocalcaneal Arthrodesis with Large Bony Defects. Foot & Ankle International,38(1), 96-106. doi:10.1177/1071100716681743.