Midfoot beam-plate constructs for Charcot neuroarthropathy: A Cohort study with midterm follow-up

The technique of intramedullary beaming of the metatarsals with a supplemental medial locking plate is an emerging technique to achieve and maintain plantigrade, ulcer-free feet in patients with Charcot neuroarthropathy. A retrospective chart review was performed to evaluate radiographic and clinical outcomes for 40 patients (41 limbs) with Charcot neuroarthropathy after operative management with medial beam-plate constructs between January 2014 and October 2023. Lateral Meary's angle was measured pre- and postoperatively to serve as a proxy for surgical correction of midfoot Charcot deformity. The mean age of the cohort was 57.6 (range, 37-73) years and 43.9 % (18/41) had an ulcer present at time of surgery. Mean clinical follow-up was 29.1 (range, 4-80) months. 94.4 % (17/18) of ulcers present at the time of surgery healed. Seven (17.1 %) patients in our cohort underwent a major amputation. The amputation rate after adopting the medial beam-plate construct approach decreased by 26 % compared with our institutional baseline data of patients treated with other techniques. Preoperative lateral Meary's angle averaged -31.0 degrees, immediate postoperative measured -5.3 degrees (p < 0.001), and final postoperative was -14.4 degrees (p < 0.001). Patients undergoing medial beam-plate constructs had a relatively low rate (17.1 % [7/41]) of major amputation, and a large portion of the remaining patients (82.4 %[28/34]) achieved a plantigrade, shoeable, ulcer-free foot at final follow-up. Active ulceration may not be a contraindication to open reconstructive surgery. Furthermore, medial beam-plate construct demonstrated radiographic maintenance of deformity at final follow-up.