1-Year Costs Prior to Midfoot Reconstruction in Patients with Charcot Neuroarthropathy

Abstract

Category: Midfoot/Forefoot, Midfoot/Forefoot

Keywords: Charcot, Charcot Arthropathy, Cost

Introduction/Purpose: Charcot neuroarthropathy (CN) is a progressive condition of joint and bone destruction in the setting of peripheral neuropathy, most often due to long-standing diabetes. Preoperative outpatient care for CN is extensive, typically involving frequent imaging, bracing or total contact casting, and wound care. Although early diagnosis and aggressive offloading can reduce the need for surgery, many patients ultimately require surgical intervention, most commonly midfoot reconstruction, when conservative measures fail. Despite the high intensity of preoperative care, the associated costs remain poorly defined. A clearer understanding of this economic burden may inform health policy and improve resource allocation. This study aims to quantify preoperative healthcare costs in patients undergoing midfoot reconstruction for CN.

Methods: A retrospective analysis was performed using the PearlDiver database to identify patients with ≥1 year of prior data who underwent midfoot reconstruction for CN between 2015–2023. Patients with fractures at the time of surgery were excluded. Reimbursement was used as a proxy for cost. Included costs comprised office visits, imaging (X-ray, MRI, CT), physical therapy (PT), medications (NSAIDs, opioids), offloading devices (orthotics, bracing, casting), prior foot surgeries (debridement, exostectomy), wound care (visits, procedures, supplies), steroid injections, vascular studies (angiography, Doppler), ankle-brachial index (ABI) and toe pressure testing, and hyperbaric oxygen therapy (HBOT). Per-patient average reimbursement (PPAR) was calculated over the 12-month preoperative period and stratified into 0–3, 3–6, and 6–9 month intervals to evaluate cost trends.

Results: A total of 1,260 patients met inclusion criteria. Total preoperative cost was $67,263,820, with a one- year PPAR of $13,635.48. Major cost contributors included imaging ($15,550,069, 23.1%), office visits ($14,578,919, 21.7%), wound care ($5,735,609, 8.5%), vascular studies ($5,610,286, 8.3%), prior foot surgeries ($4,995,744, 7.4%), bracing/offloading devices ($4,337,181, 6.4%), opioids ($8,268,446, 12.3%), and NSAIDs ($4,352,344, 6.5%). Additional costs arose from PT, ABI testing, HBOT, injections, and dressing supplies. PPAR peaked in the 6–9 month period before surgery ($13,736.88), followed by the 0–3 month ($13,270.88) and 3–6 month ($11,280.47) intervals.

Conclusion: The preoperative cost burden for CN patients undergoing midfoot reconstruction is substantial, averaging $13,635 per patient annually. Imaging, office visits, wound care, vascular studies, and prior foot surgeries accounted for the largest cost shares, reflecting the multidisciplinary nature of CN management. Cost intensity peaked 6–9 months prior to surgery, suggesting that high-cost interventions are often initiated well before operative planning. These findings highlight the importance of early risk stratification, coordinated care pathways, and potential cost-containment strategies to optimize resource utilization and reduce financial burden for this high-risk patient population.