SURGICAL-TREATMENT OF NEUROARTHROPATHIC FOOT DEFORMITY

Twenty-seven feet with neuroarthropathic fracture resulting in Signifi cant deformity were treated with surgical reconstruction. The average age of the patients was 57 years with 21 patients having diabetes mell itus an average of 24 years, Five patterns of midfoot collapse were id entified, The most common patterns involved abduction and dorsal displ acement of the forefoot with equinus of the hindfoot, Preoperative eva luation included a medical assessment, adequate control of blood sugar , and a comprehensive vascular evaluation. Five patients presented for surgical consultation with open planter ulcers, Four were healed with total contact casting alone whereas one patient required an exostecto my to heal the ulcer before surgery. After reconstruction, all feet ha d improvement in their weightbearing posture. For feet with midfoot in volvement, the average anteroposterior tale-first metatarsal angle inc reased 5 degrees, and the average lateral tale-first metatarsal angle decreased 6.5 degrees. There was no significant loss of correction at long term follow-up, The average time in a cast postoperatively was 5. 7 months, and the time to unrestricted weightbearing was 7 months. All patients were able to wear over-the-counter footwear postoperatively, Significant complications included six nonunions and two feet with ex tension of the neuroarthropathic process, One nonunion required revisi on surgery, and the feet with extension of their neuroarthropathic fra ctures required conversion of a triple arthrodesis to a pantalar fusio n and the addition of a triple arthrodesis after a successful midfoot fusion. No infections or amputations occurred as a result of the surge ry, Function increased and pain decreased as a result of successful ar throdesis. Surgical reconstruction of midfoot, hindfoot, and ankle neu roarthropathic deformity is a viable alternative to amputation for pat ients who fail nonoperative care. proper preoperative evaluation and a ssessment will result in a rate of complications comparable to foot su rgery in nondiabetic patients.