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Comparison of Diabetic Charcot Patients With and Without Foot Wounds
Dane K Wukich1, David Sadoskas2, Nicholas J Vaudreuil3
11 Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Charcot neuroarthropathy (CN) foot wounds significantly increase amputation risk. Early intervention and reconstruction offer a 90% limb salvage rate for eligible patients, highlighting the importance of wound status in treatment outcomes.
Area of Science:
- Podiatry
- Orthopedic Surgery
- Diabetic Foot Complications
Background:
- Charcot neuroarthropathy (CN) is a severe complication of diabetic neuropathy.
- Tertiary care centers manage complex CN cases, often involving foot deformities and wounds.
- The impact of Charcot-related foot wounds on limb salvage outcomes requires further investigation.
Purpose of the Study:
- To evaluate limb salvage rates in patients with diabetic Charcot neuroarthropathy (CN).
- To compare outcomes between CN patients with and without Charcot-related foot wounds.
- To identify risk factors associated with major lower extremity amputation in CN patients.
Main Methods:
- Retrospective, case-control study of 245 patients (280 feet) with diabetic CN from 2005-2015.
- Patients were divided into groups based on the presence or absence of a Charcot-related foot wound at presentation.
- Surgical and non-operative treatment outcomes, including amputation rates, were analyzed.
Main Results:
- Overall, 72.1% of feet required surgery, with a 90% limb salvage rate for reconstructive candidates.
- Feet with Charcot-related foot wounds had a significantly higher amputation rate (21.3%) compared to those without wounds (4.5%).
- The presence of a wound increased the odds of amputation by a factor of 6 (OR 6.02, P < .0001).
Conclusions:
- Charcot-related foot wounds at presentation are a significant risk factor for major lower extremity amputation in CN patients.
- Active infection, post-reconstruction instability, and postoperative wound complications also increase amputation likelihood.
- Successful limb salvage is achievable in 90% of reconstructive candidates, emphasizing the importance of wound management.
Background:
The primary aim of this study was to evaluate the outcomes of a series of patients with Charcot neuroarthropathy (CN) who were evaluated in a tertiary care setting. We hypothesized that those patients with CN who presented with a Charcot-related foot wound would have lower rates of successful limb salvage than patients who presented without a wound.
Methods:
Two hundred forty-five patients (280 feet) were identified with diabetic CN during the time period from January 1, 2005, to June 1, 2015. This consecutive cohort of patients was treated by a single surgeon and had a mean age of 57.9 ± 10.0 years. Our CN patients were divided into 2 groups for the purpose of our analysis. Our study group included those patients who presented to our clinic with a Charcot-related foot wound. Our control group was composed of CN patients who presented without a Charcot-related foot wound.
Results:
Overall, 78 feet (27.9%) were successfully treated nonoperatively and 202 feet (72.1%) required some type of surgery. Of the 202 feet that received surgery, 22 (10.9%) were not felt to be suitable for reconstruction and underwent a definitive transtibial amputation without an attempt at reconstruction. An additional 18 patients underwent soft tissue surgery, which included drainage of infection, posterior muscle group lengthening, or soft tissue reconstructive flap surgery. The remaining 162 feet underwent osseous surgery, which included ostectomies for osteomyelitis, exostectomies, osteotomies, and arthrodesis. Eighteen of the 180 limbs (10.0%) that underwent soft tissue or osseous reconstruction ultimately required a transtibial amputation, resulting in a successful limb salvage rate of 90.0%. Thirty-five amputations were performed in 164 feet (21.3%) with Charcot-related foot wounds compared with 5 amputations in 116 feet (4.5%) without Charcot-related foot wounds (OR 6.02, 95% CI 2.28-15.91, P < .0001).
Conclusion:
The presence of a Charcot-related foot wound at presentation increased the likelihood of a major lower extremity amputation by a factor of 6. Other risk factors that were associated with major amputation in patients included active infection at presentation, nonunion/instability after reconstruction, and a postoperative wound problem. The overall rate of successful limb salvage in patients deemed reconstructive candidates was 90%.
Level Of Clinical Evidence:
Level III, retrospective, case-control study.
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