Midfoot Charcot Neuro-arthropathy Precipitated by First or Fifth ray Amputation

Area of Science:

• Diabetic foot complications
• Podiatric surgery
• Neuropathic osteoarthropathy

Background:

• Charcot neuro-arthropathy (CN) often follows foot trauma in neuropathic patients.
• An association between 1st and 5th ray amputations and midfoot CN was observed.
• A 6-year retrospective analysis was conducted to evaluate this association.

Purpose of the Study:

• To analyze the incidence of midfoot CN following 1st and 5th ray amputations.
• To identify risk factors, including stump length and patient demographics, for developing CN post-amputation.
• To improve clinical practice regarding foot protection after these specific amputations.

Main Methods:

• Retrospective review of diabetic adults with peripheral neuropathy undergoing 1st or 5th ray amputation (2013-2019).
• Collection of patient demographics, stump length, CN development, imaging, and surgical outcomes.
• Comparison of patients who developed CN (CN group) with those who did not (non-CN group).

Main Results:

• 16 out of 92 patients (17.4%) developed midfoot CN post-amputation (9 after 1st ray, 7 after 5th ray).
• CN developed within 6 months to 3 years post-surgery.
• Logistic regression indicated age as a significant risk factor (p=0.013); stump length showed no diagnostic value (AUC=0.42).

Conclusions:

• This is the first report linking 1st and 5th ray amputations to midfoot CN development.
• These amputations may destabilize the foot, increasing midfoot pressure.
• Enhanced foot protection is recommended post-1st and 5th ray amputation, pending further research on stump length correlation.