title: Radiographic analysis of diabetic midfoot charcot neuroarthropathy with and without midfoot ulceration.
abstract: BACKGROUND
  The aim of this study was to evaluate weight-bearing radiographs in patients with and without foot ulcers diagnosed with midfoot Charcot neuroarthropathy (CN) secondary to diabetes mellitus.
  
  
  METHODS
  One hundred fourteen patients with midfoot CN (50 with foot ulcers and 64 without ulcers) were identified and included in this study. Nine radiographic measurements were made (7 in the sagittal plane and 2 in the transverse plane).
  
  
  RESULTS
  CN patients with foot ulcers had significantly greater deformity when assessing the lateral-talar first metatarsal angle, calcaneal pitch, cuboid height, medial column height, calcaneal-fifth metatarsal angle, talar declination, and lateral tibiotalar angle. Two measurements in the transverse plane (hindfoot-forefoot angle and AP talar first metatarsal angle) were not significantly different between the 2 groups. Of patients with foot ulcers, 24% had a lateral talar first metatarsal angle of less than -27 degrees and 80% had a negative cuboid height.
  
  
  CONCLUSIONS
  Sagittal plane deformities were more likely to be associated with foot ulceration in patients with CN than transverse plane deformities. Lateral column involvement was associated with a worse prognosis than medial column involvement, thus we believe progressive deformity of the lateral column should be monitored closely to prevent foot ulceration. Lateral column involvement could be identified by a decrease in the cuboid height, decreased calcaneal pitch, and decreased lateral calcaneal fifth metatarsal angle. This study can assist physicians in stratifying the risk for both ulceration and need for surgery in patients with CN based on reproducible radiographic measurements.
  
  
  METHODS
  Level III, comparative series.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA UPMC Mercy Center for Healing and Amputation Prevention, Pittsburgh, PA, USA wukichdk@upmc.edu.
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
authors.affiliation: Department of Plastic Surgery, Division of Wound Healing, Georgetown University School of Medicine, Washington, DC, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Raspovic
authors.affiliation: UPMC Mercy Center for Healing and Amputation Prevention, Pittsburgh, PA, USA.
authors.forename: Kimberlee B
authors.initials: KB
authors.lastname: Hobizal
authors.affiliation: Department of Epidemiology and Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
authors.forename: Bedda
authors.initials: B
authors.lastname: Rosario
mesh_terms: D001177:Arthropathy, Neurogenic / Q000000981:diagnostic imaging; D003710:Demography; D017719:Diabetic Foot / Q000000981:diagnostic imaging*; D005260:Female; D016523:Foot Ulcer / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016474:Weight-Bearing
keywords: Charcot neuroarthropathy; deformity; diabetes; ulcers