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New Surgery for Charcot Foot
Bring on the (not so heavy) metals...With an increase of morbidly obese diabetics, experts say, we are seeing more new cases of Charcot foot, a condition that can make walking nigh impossible, and may require amputation. But a surgery that secures foot bones with an external frame has enabled more than 90% of patients to walk normally again, according to Loyola University Health System foot and ankle surgeon Dr. Michael Pinzur.
This circular external fixator is a rigid frame made of stainless steel and aircraft-grade aluminum. It contains three rings that surround the foot and lower calf. The rings have stainless-steel pins that extend to the foot and secure the bones after surgery.
Charcot foot can occur in a diabetic who has neuropathy in the foot that impairs the ability to feel pain. Because the patient doesn’t feel an injury, he or she keeps walking, making things worse. Bones fracture, joints collapse and the foot becomes deformed. The patient walks on the side of the foot and develops pressure sores. Bones can become infected. The excess weight increases the risk of diabetic neuropathy (and the risk that patients with diabetic neuropathy will develop Charcot foot).
Surgery in which bones are held by internal plates and screws don’t work with some obese Charcot patients. Their already weakened bones could collapse under the patient’s weight. While patients are often put into casts, bones can heal in deformed positions. And, it is difficult or impossible for obese patients to walk on one leg when the other leg is in a cast. Patients typically must use wheelchairs and are confined to the first story of the house for as long as nine months. And after the cast comes off, they must wear a cumbersome leg brace. Those treated with an external fixator often are able to walk or at least bear some weight on the treated leg. The device is attached to the leg for only two or three months.
In 2007 Dr. Pinzur published a study whereby he followed 26 obese, diabetic Charcot foot patients. After surgery, the foot bones were held in place by the external fixator. A year or more later, 24 of the 26 patients had no ulcers or bone infections and were able to walk without braces.
Dr. Pinzur told OTW,
I did not develop the fixator; this is a classic Illizarov fixator. I have simply used it in this specific patient population. Several orthopaedic device companies have invested a lot of money in Charcot, thinking that the role of external and internal fixation will greatly pick up in this patient population. As for spreading the word on this topic, I have done many national presentations on the role of external fixation in Charcot Foot.