Foot Surgery Can Lead to Bone Degeneration in Diabetic Patients

For release Feb. 7, 1999 Contact Brad Chrisman, 206-223-1120, >brad@aofas.org

Foot surgery can lead to bone degeneration in diabetic patients

ANAHEIM -- Elective foot and ankle surgery for diabetic patients can lead to increased risk of bone and joint degeneration, according to a study presented at the American Orthopaedic Foot and Ankle Society Annual Winter Meeting in Anaheim, February 7, 1999. Because of nerve damage, diabetic patients become insensitive to foot pain and thus are susceptible to recurrent ulcerations, foot and ankle instability and deformities that make it impossible to wear shoes or braces. Surgery to correct these problems can lead to Charcot neuropathic arthropathy, a destructive form of bone and joint degeneration seen in insensate patients. "Surgery may be successful in treating the original problem, but the patient becomes susceptible to developing Charcot disease," said Robert B. Anderson, M.D., Miller Orthopaedic Clinic, Charlotte, NC, senior author of the study. "We're finding that surgery is no different that any other insult to the diabetic foot," said Dr. Anderson. "It can be done with caution and with a clear explanation to the patient that Charcot disease may develop." At one time, the treatment of choice for diabetic patients with severe foot complications was amputation. Approximately one half of all foot amputations in the U.S. are for complications due to diabetes. "Orthopaedic surgeons now are performing more procedures to prevent foot amputation," noted Dr. Anderson. "As a result, we are seeing more complications such as Charcot foot deformity." Dr. Anderson suggested physicians need to have a greater degree of awareness of the complications of charcot deformity in diabetic patients who have elective surgery. Physicians also need to take measures to prevent or reduce the risk of charcot such as immobilizing patients in a nonweightbearing cast after surgery for an extended period of time. The study looked at 25 patients who developed Charcot foot following elective surgery performed by orthopaedic surgeons at the Miller Orthpaedic Clinic in Charlotte. Most of the patients (21 of 25) had documented pre-existing nerve damage (peripheral neuropathy). None had evidence of Charcot deformity prior to the surgery. The average time to Charcot diagnosis was 11 weeks (range 4 to 30 weeks). David Banks, M.D., Charlotte, NC, presented the paper. Other authors were Richard E. Gellman, M.D., W. Hodges Davis, M.D., also from the Miller Clinic.