Abstract
Category:
Diabetes; Midfoot/Forefoot
Introduction/Purpose:
The management of glycemic levels in the perioperative setting is considered vital for reducing post-operative complications among patients with diabetes undergoing elective foot and ankle surgery. The current guidelines recommend a target HbA1c of 8.5. Patients waiting for Charcot foot deformity corrections with complicated diabetes often have extremely impaired mobility levels and fail to achieve adequate pre-operative glycemic control and risk getting their surgeries cancelled or postponed as a result. In our diabetic foot unit, the multidisciplinary team (MDT) recommends proceeding with surgery even if the target HbA1c levels are not achieved for those patients waiting for time-critical Charcot foot reconstructions despite their best efforts.
To review the patient outcomes among patients with diabetes and variable pre-operative glycemic control undergoing Charcot foot reconstructions.
Methods:
We have reviewed the clinical outcomes of consecutive patients that had undergone elective Charcot foot reconstructions under the senior author with a minimum follow-up of 12 months. We have also reviewed the glycemic control achieved at 12 months post-reconstruction.
Results:
A total of 18 patients were operated between October 2020-August 2022. This included 8 midfoot, 2 hindfoot and 8 combined hindfoot-midfoot reconstructions. There were 11 males, with mean age 56.7 years (34-77). 10 had type 1 diabetes and 8, type 2. The mean preoperative HbA1c was 7.9 (5.4-11.8). The mean duration of waiting for surgery since the decision was 11 months. In 7 patients, the recommended target of 8.5 was not achieved (non-target group) within 6 weeks of their surgery. After one year 61% (n= 11) of the patients were able to mobilise independently in shoes. There was no difference in the outcomes between the patient groups with or without the targeted glycemic control. Postoperative HbA1c levels were available for 11 patients at 12 months.
Conclusion:
Although pre-operative glycemic optimization should be aimed for, the time critical Charcot foot reconstructions can still be performed in the absence of targeted glycemic control if delivered by MDT.