Abstract
Category:
Midfoot/Forefoot; Diabetes
Introduction/Purpose:
The optimal timing to surgically intervene in Charcot foot arthropathy remains controversial. Classical teaching is to avoid intervention in the active stage of Charcot foot, because of the worry of soft tissue and bony complications. However, several authors had advocated the paradigm shift to intervene early in active Charcot foot, to allow deformity correction and stabilization before further deformity develops. This article aims to investigate the current pattern of paradigm shift and the outcomes after intervention in the active and inactive stages of Charcot foot.
Methods:
This study was done in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis). A literature search was done on Pubmed, Embase, Cochrane Library, and Clinicaltrials.gov. An effort was made to search for all relevant articles in unpublished sources such as conferences as well as the reference list of included studies. All relevant articles published within the last 5 years were included, with the exclusion of case reports.
Results:
269 articles were screened, and 17 studies were included. There were 11 studies with surgery in the inactive stage of Charcot foot, 6 studies with surgery in both the active and inactive stages of Charcot foot, and no study was done in the active stage alone. The amputation rate for surgery in the inactive stage was 10.5% while that of active and inactive stages was 12.3%. The re-operation rate for surgery in the inactive stage was 31.2% while that of active and inactive stages was 50.0%. The non-union rate after surgery in the inactive stage was 13.0% while that of active and inactive stages was 32.5%.
Conclusion:
Most surgeons still prefer to intervene surgically in the inactive stage of Charcot foot. Amputation rate, re-operation rate, and non-union rates were higher in studies that included surgery in both active and inactive stages of Charcot foot. Therefore, surgeons should be cautious in deciding optimal surgical timing for Charcot foot reconstruction and avoid the active stage of the disease if possible.