title: MIDFOOT CHARCOT ARTHROPATHY IN DIABETIC PATIENTS: COMPLICATION OF AN EPIDEMIC DISEASE.
abstract: OBJECTIVE
  To outline the epidemiological profile of diabetic patients with Charcot arthropathy affecting the midfoot alone or extending from the midfoot to the hindfoot; To assess the results from the treatment that these patients undergo, according to a preestablished protocol, over the medium term.
  
  
  METHODS
  We retrospectively evaluated 88 patients (110 extremities) with Charcot arthropathy of the midfoot. The minimum follow-up period was 12 months. We included 45 patients with Charcot arthropathy affecting the tarsal-metatarsal joints (51%); 20 patients in whom the talonavicular, calcaneocuboid and subtalar joints were affected (23%); and 23 patients in whom both the midfoot and hindfoot were affected (26%), as described by Brodsky and Trepman. We defined the treatment as successful when a functional foot was preserved; and unsuccessful when the foot was amputated.
  
  
  RESULTS
  From treating Charcot arthropathy primarily involving the midfoot were satisfactory in the cases of 75 patients (85%) treated according to our protocol. For the patients with severe lesions affecting both the midfoot and the hindfoot, a greater number of complex operations (i.e. arthrodesis) were needed in order to obtain the same overall rate of satisfactory results. The osteoarticular lesions originating in the midfoot probably extended progressively to the hindfoot because of delayed diagnosis with inadequate early treatment.
  
  
  CONCLUSIONS
  It was possible to preserve a functional extremity in 85% of the patients. Severe lesions involving the midfoot and extending to the hindfoot required a greater number of surgical procedures to treat them.
authors.affiliation: PhD. Professor and Head of the Foot and Ankle Surgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.
authors.forename: Ricardo Cardenuto
authors.initials: RC
authors.lastname: Ferreira
authors.affiliation: Third-year Resident Physician in Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.
authors.forename: Daniel Hidalgo
authors.initials: DH
authors.lastname: Gonçalez
authors.affiliation: Third-year Resident Physician in Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.
authors.forename: João Manoel Fonseca
authors.initials: JM
authors.lastname: Filho
authors.affiliation: MSc. Attending Physician in the Foot and Ankle Surgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.
authors.forename: Marco Túlio
authors.initials: MT
authors.lastname: Costa
authors.affiliation: PhD. Professor and Consultant in the Foot and Ankle Surgery Group, Department of Orthopedics and Traumatology, Santa Casa de São Paulo, São Paulo, SP, Brazil.
authors.forename: Roberto Attilio Lima
authors.initials: RA
authors.lastname: Santin
keywords: Amputation; Arthropathy, Neurogenic; Diabetes; Foot