title: Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique.
abstract: BACKGROUND
  The failure of nonsurgical treatment of patients with midfoot and hindfoot deformity secondary to diabetic Charcot arthropathy may lead to a rocker-bottom foot deformity with recurrent or persistent plantar ulceration. We report our experience with realignment and extended fusion with primary use of a medial column screw for this midfoot deformity.
  
  
  METHODS
  From July 2001 through July 2005, we performed reconstructive surgery on fifteen adults with diabetes mellitus who had a severe neuropathic midfoot deformity consisting of a collapsed plantar arch with a rocker-bottom foot deformity. Thirteen had a nonhealing midfoot plantar ulcer. All underwent realignment and arthrodesis with a medial column screw; some required additional fixation techniques depending on the extent of the deformity. Outcome measures included ulcer and surgical wound-healing, radiographic results, complications, and the need for amputation.
  
  
  RESULTS
  The mean duration of clinical follow-up was forty-two months. Fourteen patients were able to walk, and there were no recurrent plantar ulcers. Thirteen patients were able to wear custom-made extra-depth, wide-toed shoes with molded inserts. One patient without prior ulceration had development of a deep infection that necessitated an amputation. Four feet had a nonunion, one of which was symptomatic requiring a revision to obtain union.
  
  
  CONCLUSIONS
  Surgical reconstruction of a collapsed neuropathic foot deformity is technically demanding, but a successful outcome can result in a plantigrade foot that is free of ulceration and abnormal pressure points and a patient who is able to walk. The procedure described has an acceptable degree of complications although it has a high rate of nonunion.
authors.affiliation: Service de Chirurgie Orthopédique et Traumatologiede l'Appareil Moteur, Hôpitaux Universitaires de Genève, 24 rue Micheli-du-Crest, Genève 14, Switzerland.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Assal
authors.forename: Adrien
authors.initials: A
authors.lastname: Ray
authors.forename: Richard
authors.initials: R
authors.lastname: Stern
mesh_terms: D001174:Arthrodesis / Q000379:methods*; D001863:Bone Screws; D016025:Bone Transplantation; D017719:Diabetic Foot / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D006801:Humans; D011182:Postoperative Care; D011859:Radiography; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016474:Weight-Bearing