Original Research
Beaming the Columns for Charcot Diabetic Foot Reconstruction: A Retrospective Analysis

https://doi.org/10.1053/j.jfas.2010.12.002Get rights and content

Abstract

This study explored the concept of “beaming” the medial and lateral longitudinal columns as a variation of the current technique for hindfoot and Lisfranc Charcot reconstruction. We reviewed radiographic changes and outcomes for patients who underwent Charcot foot reconstruction at our facility over the 14-year period from January 1994 to January 2008. Beaming was performed on 71 Charcot foot deformities in 70 patients, 22 (31%) of which displayed an isolated hindfoot deformity, 20 (28%) an isolated Lisfranc deformity, and 29 (41%) with a combination of hindfoot and Lisfranc deformities. The average radiographic follow up was 31.00 ± 22.97 months. Group 1 consisted of reconstructions that involved only medial and lateral column beams and showed significant improvements in radiographic alignment between the preoperative and postoperative measurements, including Meary’s angle (P < .001), calcaneal inclination angle (P = .004), tarsometatarsal angle (P = .002), talonavicular angle (P = .035), and the calcaneocuboid angle (P = .006). Group 2, which consisted of reconstructions that involved medial and lateral column beams and either a subtalar arthroereisis (n = 18) or a subtalar joint fusion (n = 10), also showed significant improvements, including Meary’s angle (P < .001), tarsometatarsal angle (P < .001), talonavicular angle (P = .002), and the calcaneocuboid angle (P < .001), although calcaneal inclination did not statistically significantly change (P = .054). In both groups, the surgical intervention maintained the correction and was useful for Charcot reconstruction. Complications included pin tract infections, broken pin, osteomyelitis, transfer lesions, and ulcerations.

Section snippets

Patient Population

We reviewed 71 Charcot foot surgical reconstructions, performed in 70 patients treated in the private practice of the senior author (W.P.G.) from January 1994 to January 2008. All of the patients had peripheral neuropathy with loss of protective sensation, as determined by the absence of 10-gram monofilament skin sensation on 3 separate areas of the involved foot, and included Type 1 and Type 2 diabetic patients, as well as one nondiabetic patient with idiopathic peripheral neuropathy. Charcot

Results

The study included 70 patients (43 males and 27 females) with a mean age of 56.10 ± 11.29 (range 29–78) years, and an average body mass index (BMI) of 33.10 ± 6.83 (range 21.3–51.2). Seventy-one Charcot foot reconstructions (35 right and 36 left sides) were performed along with 1 bilateral case. The mean duration of time to procurement of the postoperative radiographs used to measure the radiographic angles used in the analyses was the mean follow-up duration of 31.00 ± 22.73 (range 3–92)

Discussion

In this study, the effect of beaming on the medial and lateral columns showed statistically significant improvements for a large subgroup of patients who underwent the beaming procedures. Beaming of the medial column entails placement of an intramedullary fixation screw through the medullary canal of the first metatarsal, then through the medial cuneiform and the navicular, and onward into the body of the talus. The beam acts to share the load with the bones, ligaments, and joints of the foot,

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    Conflict of Interest: None reported.

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