Beaming in the Charcot foot: A case series with 12-month minimum follow-up. (June 2021) - Dos Santos-Vaquinhas, A.
Highlights: Charcot neuropathic arthropathy is a destructive fast-progressive arthropathy. Charcot neuropathic arthropathy often results in loss of independent walking and amputation of the leg. The goal of surgical treatment is restoration of a functional plantigrade foot and an ulcer-free autonomic deambulation. Beaming of the medial and lateral columns of the foot enables a significant correction. Beaming can lead to the restoration of a functional plantigrade foot and an ulcer-free autonomic deambulation. Abstract: Background: Charcot neuropathic arthropathy is a progressive degeneration of the weightbearing joints of the foot induced by denervation and disturbance of sensorial perception. This entity clinically behaves as a destructive fast-progressive arthropathy, resulting in loss of independent walking and often requiring amputation of the leg. This study analyzes our experience with midfoot realignment arthrodesis and stabilization by intramedullary beaming in patients with Charcot diabetic foot as a limb-sparing procedure. Methods: Patients with Charcot foot treated in our Foot and Ankle unit between January 2018 and December 2019 were analyzed. In all of the patients beaming technique was performed: open reduction and stabilization by a midfoot medial fusion beam and a lateral fusion bolt. Demographical, clinical and radiological pre and post-surgery data were assessed. The primary outcome measure was defined as an autonomous ambulation through an ulcer-free plantigrade foot. A minimum follow-up of 12 months was performed. Results: A total of 5 patients were treated. Median age 64 years, mean follow-up 25 months (12–31). An ulcer-free plantigrade foot was obtained in 80% of the patients. Complications were observed in 80% of patients: 1 deep infection, 2 hardware failure, 3 Charcot foot progression. Rate of reoperation 40%, including 1 amputation. Significant improvement in all radiographic angles was observed. Conclusion: Beaming the medial and lateral columns of the foot in patients with Charcot foot enabled the restoration of a functional plantigrade foot and an ulcer-free autonomous ambulation, despite a relatively high complication rate. Level of evidence: IV, prospective case series.