Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot Foot
Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot foot is a serious complication that arises in the setting of combined peripheral neuropathy and trauma. This neurodegenerative disease is often associated with diabetes mellitus and other chronic comorbid diagnoses which can further...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-12-01
|
| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011423S00417 |
| _version_ | 1797374945933656064 |
|---|---|
| author | Taylor Lan BA Kelly Dopke BS Andrea Shehaj BS Christian Benedict Natalie Pahapill BS Kirsten N. Mansfield MPH Christopher Stauch MD Kaitlin L. Saloky MD Michael Aynardi MD |
| author_facet | Taylor Lan BA Kelly Dopke BS Andrea Shehaj BS Christian Benedict Natalie Pahapill BS Kirsten N. Mansfield MPH Christopher Stauch MD Kaitlin L. Saloky MD Michael Aynardi MD |
| author_sort | Taylor Lan BA |
| collection | DOAJ |
| description | Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot foot is a serious complication that arises in the setting of combined peripheral neuropathy and trauma. This neurodegenerative disease is often associated with diabetes mellitus and other chronic comorbid diagnoses which can further lead to an increased risk of other injuries such as bone deformities and ulcerations. As there is no standard protocol for the management and treatment of Charcot neuroarthropathy (CN), casting, arthrodesis, exostectomy, and amputation can all be utilized. The understanding of the various comorbidities and management strategies for Charcot foot may allow further guidance for treatment options. The objective of our study was to compare the demographics, lab values, and clinical outcomes of patients who undergo various treatment modalities for CN and determine if there was correlation. Methods: A sample of patients at a single institution diagnosed with CN of the lower extremity and who underwent exostectomy, arthrodesis, amputation, and/or casting were identified through TriNetX. Demographics were collected for the study sample including age, sex, and race. Descriptive statistics in addition to historic and projected rate of arrival were conducted on each subgroup of patients. Relative risk with the associated confidence intervals were completed to assess comparative statistics among the groups for various organ system based comorbid diagnoses and complications. Results: Three-hundred and forty patients were identified; 120 underwent amputation, 130 underwent arthrodesis, 180 underwent exostectomy, and 160 underwent casting. The average age was 62 ± 12 years. Males accounted for 62%, with a higher percentage (66%) in the amputation and exostectomy groups. 85% of patients identified as white. The predicted rate of arrival at this institution for amputation, arthrodesis, exostectomy, and casting was 2.4, 0.7, 2.5, and 4.7 respectively. Amputation was overall associated with a higher percentage of comorbid diagnosis. When compared to the arthrodesis group, casting had a 1.35 times (95% CI: 1.086-1.689) risk of ulceration and was associated with a higher hemoglobin A1C (7.5±2.211 vs 7.22 ± 1.87, p=0.058). Conclusion: Among relatively comparable groups, casting, while effective and the least invasive, is associated with higher risks of ulceration and complications in the future. Complications of Charcot foot can involve skeletal deformities, which can reduce the quality of life for patients. With the expected projected arrival rate of newly diagnosed CN patients at this institution to be highest for casting and lowest for arthrodesis, the consideration for early surgical intervention such as arthrodesis could reduce the risk of complications and readmissions in the future progression of Charcot foot. |
| first_indexed | 2024-03-08T19:13:05Z |
| format | Article |
| id | doaj.art-f90645dd34e14ec8888de06b48f3f318 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-03-08T19:13:05Z |
| publishDate | 2023-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-f90645dd34e14ec8888de06b48f3f3182023-12-27T10:03:18ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142023-12-01810.1177/2473011423S00417Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot FootTaylor Lan BAKelly Dopke BSAndrea Shehaj BSChristian BenedictNatalie Pahapill BSKirsten N. Mansfield MPHChristopher Stauch MDKaitlin L. Saloky MDMichael Aynardi MDCategory: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot foot is a serious complication that arises in the setting of combined peripheral neuropathy and trauma. This neurodegenerative disease is often associated with diabetes mellitus and other chronic comorbid diagnoses which can further lead to an increased risk of other injuries such as bone deformities and ulcerations. As there is no standard protocol for the management and treatment of Charcot neuroarthropathy (CN), casting, arthrodesis, exostectomy, and amputation can all be utilized. The understanding of the various comorbidities and management strategies for Charcot foot may allow further guidance for treatment options. The objective of our study was to compare the demographics, lab values, and clinical outcomes of patients who undergo various treatment modalities for CN and determine if there was correlation. Methods: A sample of patients at a single institution diagnosed with CN of the lower extremity and who underwent exostectomy, arthrodesis, amputation, and/or casting were identified through TriNetX. Demographics were collected for the study sample including age, sex, and race. Descriptive statistics in addition to historic and projected rate of arrival were conducted on each subgroup of patients. Relative risk with the associated confidence intervals were completed to assess comparative statistics among the groups for various organ system based comorbid diagnoses and complications. Results: Three-hundred and forty patients were identified; 120 underwent amputation, 130 underwent arthrodesis, 180 underwent exostectomy, and 160 underwent casting. The average age was 62 ± 12 years. Males accounted for 62%, with a higher percentage (66%) in the amputation and exostectomy groups. 85% of patients identified as white. The predicted rate of arrival at this institution for amputation, arthrodesis, exostectomy, and casting was 2.4, 0.7, 2.5, and 4.7 respectively. Amputation was overall associated with a higher percentage of comorbid diagnosis. When compared to the arthrodesis group, casting had a 1.35 times (95% CI: 1.086-1.689) risk of ulceration and was associated with a higher hemoglobin A1C (7.5±2.211 vs 7.22 ± 1.87, p=0.058). Conclusion: Among relatively comparable groups, casting, while effective and the least invasive, is associated with higher risks of ulceration and complications in the future. Complications of Charcot foot can involve skeletal deformities, which can reduce the quality of life for patients. With the expected projected arrival rate of newly diagnosed CN patients at this institution to be highest for casting and lowest for arthrodesis, the consideration for early surgical intervention such as arthrodesis could reduce the risk of complications and readmissions in the future progression of Charcot foot.https://doi.org/10.1177/2473011423S00417 |
| spellingShingle | Taylor Lan BA Kelly Dopke BS Andrea Shehaj BS Christian Benedict Natalie Pahapill BS Kirsten N. Mansfield MPH Christopher Stauch MD Kaitlin L. Saloky MD Michael Aynardi MD Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot Foot Foot & Ankle Orthopaedics |
| title | Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot Foot |
| title_full | Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot Foot |
| title_fullStr | Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot Foot |
| title_full_unstemmed | Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot Foot |
| title_short | Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot Foot |
| title_sort | surgical interventions have lowered complication rates compared to casting in charcot foot |
| url | https://doi.org/10.1177/2473011423S00417 |
| work_keys_str_mv | AT taylorlanba surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot AT kellydopkebs surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot AT andreashehajbs surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot AT christianbenedict surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot AT nataliepahapillbs surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot AT kirstennmansfieldmph surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot AT christopherstauchmd surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot AT kaitlinlsalokymd surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot AT michaelaynardimd surgicalinterventionshaveloweredcomplicationratescomparedtocastingincharcotfoot |