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Michael S. Pinzur - One of the best experts on this subject based on the ideXlab platform.

  • improvement in quality of life following operative correction of midtarsal Charcot Foot deformity
    Foot & Ankle International, 2018
    Co-Authors: Ellen Kroin, Adam Schiff, Edwin O Chaharbakhshi, Michael S. Pinzur
    Abstract:

    Background:Patients with Charcot Foot arthropathy report a poor quality of life following the development of deformity. Their quality of life is often not improved with “successful” historic accomm...

  • Deformity and Clinical Outcomes Following Surgical Correction of Charcot Foot
    Foot & Ankle Orthopaedics, 2017
    Co-Authors: Michael S. Pinzur, Adam Schiff
    Abstract:

    Category:DiabetesIntroduction/Purpose:There is growing acceptance that the historic accommodative treatment of the acquired deformity associated with Charcot Foot arthropathy leads to very poor pat...

  • Functional Impairment of Patients Undergoing Surgical Correction for Charcot Foot
    Foot & Ankle Orthopaedics, 2017
    Co-Authors: Michael S. Pinzur, Adam Schiff, Ellen Kroin
    Abstract:

    Category: Diabetes Introduction/Purpose: Investigations using the Medical Outcomes Study Short Form 36 Healthy Survey (SF-36) and the American Orthopaedic Foot and Ankle Society Diabetic Foot Questionnaire (AOFAS-DFQ) have demonstrated a poor quality of life in patients with Charcot Foot arthropathy. The Short Musculoskelatal Function Assessment (SMFA) questionnaire has been widely used in patients with a broad range of musculoskeletal disorders. Methods: Twenty-five consecutive patients undergoing surgical correction for diabetes-related Charcot Foot Arthropathy of the midFoot completed the Short Musculoskeletal Functional Assessment (SMFA) prior to undergoing surgery. There were 16 males and 9 females. The average BMI was 37.35 (range 25.83-50.22), and the average Hemoglobin A1C was 7.54 (range 5.3-10.1) prior to surgery. Results: All twenty-five patients exhibited significant impairment in all six domains of the SMFA (p<0.0001) as compared to the normative data. There was a high correlation between each of the six domains of the SMFA, even after correcting for BMI. Conclusion: Charcot Foot severely impairs quality of life in impacted patients beyond the impact of morbid obesity. This impairment equally impacts all of the functional and emotional domains measured with the SMFA as compared with population norms. This investigation provides an excellent benchmark for measuring the impact of surgical correction. In addition, the SMFA appears to be a valid tool for evaluating this complex patient population.

  • Functional Impairment of Patients Undergoing Surgical Correction for Charcot Foot Arthropathy
    Foot & ankle international, 2017
    Co-Authors: Ellen Kroin, Michael S. Pinzur, Adam Schiff, Elissa S. Davis, Edwin Chaharbakhshi, Frank Disilvio
    Abstract:

    Background:Investigations using the Medical Outcomes Study Short Form 36 Healthy Survey (SF-36) and the American Orthopaedic Foot & Ankle Society Diabetic Foot Questionnaire (AOFAS-DFQ) have demonstrated a poor quality of life in patients with Charcot Foot arthropathy. The Short Musculoskeletal Function Assessment (SMFA) questionnaire has been widely used in patients with a broad range of musculoskeletal disorders.Methods:Twenty-five consecutive patients undergoing operative correction for diabetes-related Charcot Foot arthropathy of the midFoot completed the SMFA prior to undergoing surgery. There were 16 males and 9 females. The average body mass index (BMI) was 37.4 (range 25.8-50.2), and the average hemoglobin A1c was 7.5 (range 5.3-10.1) prior to surgery.Results:All 25 patients exhibited significant impairment in all 6 domains of the SMFA (P < .0001) as compared to the normative data. There was a high correlation between each of the 6 domains of the SMFA, even after correcting for BMI.Conclusion:Char...

  • Surgical treatment of the Charcot Foot.
    Diabetes Metabolism Research and Reviews, 2016
    Co-Authors: Michael S. Pinzur
    Abstract:

    With the increased number of diabetics worldwide and the increased incidence of morbid obesity in more prosperous cultures, there has become an increased awareness of Charcot arthropathy of the Foot and ankle. Outcome studies would suggest that patients with deformity associated with Charcot Foot arthropathy have impaired health related quality of life. This awareness has led reconstructive-minded Foot and ankle surgeons to develop surgical strategies to treat these acquired deformities. This article outlines the current clinical approach to this disabling medical condition.

Thomas Zgonis - One of the best experts on this subject based on the ideXlab platform.

  • Circular External Fixation as a Primary or Adjunctive Therapy for the Podoplastic Approach of the Diabetic Charcot Foot
    Clinics in podiatric medicine and surgery, 2016
    Co-Authors: Daniel J. Short, Thomas Zgonis
    Abstract:

    Numerous techniques have been described for surgical management of the diabetic Charcot Foot. External fixation has become a main surgical tool for the reconstructive Foot and ankle surgeon when dealing with the ulcerated diabetic Charcot Foot. In the presence of an open wound and/or osteomyelitis, staged reconstruction with circular external fixation becomes ideal for salvage of the diabetic lower extremity. Also, circular external fixation can provide simultaneous compression and stabilization, correct the underlying osseous or soft tissue deformities, and surgically offload the diabetic Charcot Foot. This article describes a variety of circular external fixation applications for the diabetic Charcot Foot.

  • Negative-pressure wound therapy in the management of diabetic Charcot Foot and ankle wounds
    Diabetic foot & ankle, 2013
    Co-Authors: Crystal L. Ramanujam, John J. Stapleton, Thomas Zgonis
    Abstract:

    As the prevalence of diabetes mellitus continues to rise, innovative medical and surgical treatment options have increased dramatically to address diabetic-related Foot and ankle complications. Among the most challenging clinical case scenarios is Charcot neuroarthropathy associated with soft tissue loss and/or osteomyelitis. In this review article, the authors present a review of the most common utilizations of negativepressure wound therapy as an adjunctive therapy or combined with plastic surgery as it relates to the surgical management of diabetic Charcot Foot and ankle wounds. Keywords: negative-pressure wound therapy; Charcot Foot; diabetes mellitus; neuropathy; plastic surgery; external fixation (Published: 23 September 2013) Citation: Diabetic Foot & Ankle 2013, 4 : 20878 - http://dx.doi.org/10.3402/dfa.v4i0.20878

  • Surgical Reconstruction of the Diabetic Charcot Foot: Internal, External or Combined Fixation?
    Clinics in podiatric medicine and surgery, 2012
    Co-Authors: John J. Stapleton, Thomas Zgonis
    Abstract:

    Charcot neuroarthropathy of the Foot and ankle is a devastating neuropathic complication that can eventually lead to a lower extremity amputation in the presence of an ulceration or infection. Current surgical approaches for the management of the diabetic Charcot Foot and ankle deformities are largely based on expert opinions in various fixation methods attempting to avoid major postoperative complications. The goal of this article is to discuss the advantages and disadvantages of various internal, external, or combined fixation methods as they relate to the inherent challenges in the management of the diabetic Charcot Foot.

  • Versatility of intrinsic muscle flaps for the diabetic Charcot Foot.
    Clinics in podiatric medicine and surgery, 2012
    Co-Authors: Crystal L. Ramanujam, Thomas Zgonis
    Abstract:

    Bone, joint, and/or tendon exposure following surgical debridement of diabetic Foot infections requires careful consideration when choosing appropriate closure methods. The unique architecture of the Foot, coupled with the functional demands of mobilization, makes soft tissue reconstruction for plantar defects especially challenging. Muscle flaps incorporate the muscle, associated nerve, and vascular pedicles during transposition. This article covers their unique properties for soft tissue coverage in the diabetic Charcot Foot.

  • Salvage of Charcot Foot neuropathy superimposed with osteomyelitis: a case report
    Journal of wound care, 2010
    Co-Authors: Crystal L. Ramanujam, Thomas Zgonis
    Abstract:

    The risk of amputation is dramatically increased in diabetic patients with osteomyelitis of the Foot complicated by Charcot neuroarthropathy. Antibiotic-impregnated cement beads have been widely reported in the treatment of deep soft tissue and bone infections. This case report demonstrates that this approach can also aid the management of infected, unstable diabetic Charcot Foot.

Ole Lander Svendsen - One of the best experts on this subject based on the ideXlab platform.

  • how common is the rare Charcot Foot in patients with diabetes
    Diabetes Care, 2021
    Co-Authors: Ole Lander Svendsen, Oliver Christian Rabe, Matilde Wintherjensen, Kristine H Allin
    Abstract:

    The Charcot Foot is a devastating complication to diabetes (1). It manifests as an acute aseptic inflammation of bones and joints in the feet. If not diagnosed and treated in time, it may lead to collapse of bones in the Foot, which causes deformity, Foot ulcers, amputation, and death (1). The diagnosis of acute Charcot Foot is often delayed due to little knowledge of the disease among patients and clinicians, probably because of its rarity. But how rare is it? To answer this, we have assessed the incidence and prevalence of the Charcot Foot among all patients with diabetes in Denmark. The Danish National Patient Register contains information on all hospitalizations and information on outpatient visits and emergency room contacts from 1995 to present (2). Data about age, sex, and emigrations (temporary or permanent) were retrieved from The Danish Civil Registration System, and dates of death were found in the Death Register, Statistics Denmark (2). All individuals in the Danish National Patient …

  • Mortality and complications after treatment of acute diabetic Charcot Foot.
    Journal of diabetes and its complications, 2018
    Co-Authors: Rasmus Bo Jansen, Bo Jørgensen, Per Holstein, Klaus Kirketerp Møller, Ole Lander Svendsen
    Abstract:

    Abstract Aims Charcot Foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot Foot on a case-by-case basis, in order to assess the consequences of an acute Charcot Foot and its complications. Methods The study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot Foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry. Results In total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7 ± 21.4 mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5 ± 20.3 mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3 months). The 5-year mortality was 14% with a mean survival time of 12.7 years. There was an association between lack of compliance and occurrence of Foot complications, as well as between having a Charcot Foot and leaving the workforce. Conclusion More patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot Foot.

  • Markers of Local Inflammation and Bone Resorption in the Acute Diabetic Charcot Foot
    Journal of diabetes research, 2018
    Co-Authors: Rasmus Bo Jansen, Tomas Møller Christensen, Jens Bülow, Lene Rørdam, Niklas Rye Jørgensen, Ole Lander Svendsen
    Abstract:

    Objective. Due to the localized nature of Charcot Foot, systemically altered levels of inflammation markers can be difficult to measure. The aim of this study was to investigate whether it is possible to detect an arteriovenous (A-V) flux in any locally produced inflammatory biomarkers from an acute Charcot Foot by comparing local and systemic measurements. Methods. We included patients with acute diabetic Charcot Foot. Blood was sampled from the vena saphena magna on the distal part of the crus bilaterally as well as from the arteria radialis. To minimize the A-V shunting effect, the feet were externally cooled with ice water prior to resampling. Results. Both before and after cooling, the A-V flux of interleukin-6 (IL-6) between the Charcot feet and the arterial level was significantly higher than the flux between the healthy feet and the arterial level (Δvaluebefore: 7.25 versus 0.41 pg/mL, resp., ; Δvalueafter: 10.04 versus 1.68 pg/mL, resp., ). There were no differences in the fluxes for other markers of inflammation. Conclusion. We have found an increased A-V flux of IL-6 in the acute diabetic Charcot Foot compared to the healthy Foot in the same patients.

  • A review of bone metabolism and developments in medical treatment of the diabetic Charcot Foot.
    Journal of diabetes and its complications, 2018
    Co-Authors: Rasmus Bo Jansen, Ole Lander Svendsen
    Abstract:

    Charcot Foot is a rare but severe, and possibly limb-threatening, complication to neuropathy and diabetes mellitus. The current treatment consists of long-term off-loading, and has a large negative impact on the patient's life. Much research has gone into understanding the condition and its biochemical mechanisms, however, the underlying pathogenesis of a Charcot Foot is not yet fully understood. In the recent decades several key advances in our understanding of the Charcot Foot have been made, both in regards to the changes in bone metabolism and structure an acute Charcot Foot can cause, and to the molecular pathways involved in this. This review summerizes the available research into the bone metabolism around a Charcot Foot, with an emphasis on the biochemical profile. The existing data regarding attempts at medical treatment is also reviewed, including novel trials targetting specific inflammatory pathways upregulated in the acute diabetic Charcot Foot.

  • Long-term effects on the progress of neuropathy after diabetic Charcot Foot: an 8.5-year prospective case-control study.
    BMC research notes, 2018
    Co-Authors: Rasmus Bo Jansen, Per Holstein, Tomas Møller Christensen, Jens Bülow, Lene Rørdam, Ole Lander Svendsen
    Abstract:

    Charcot Foot is a severe complication to diabetes mellitus, associated with diabetic neuropathy. Any long-term effects of a Charcot Foot on the progress of neuropathy are still largely unexplored. The objective was to investigate whether a previous Charcot Foot had any long-term effects on the progress of neuropathy. An 8.5-year follow-up case–control study of 49 individuals with diabetes mellitus, 24 of whom also had Charcot Foot at baseline visit in 2005–2007. Neuropathy was assessed with a questionnaire, biothesiometry, heart rate variability and venous occlusion plethysmography. Of the 49 baseline participants, 22 were able to participate in the follow-up. Twelve had passed away in the meantime. Heart rate variability was unchanged in both groups; from 9.7 to 7.2 beats/min (p = 0.053) in the Charcot group, and 14.3 to 12.6 beats/min (p = 0.762) in the control group. Somato-sensoric neuropathy showed no difference between baseline and follow-up in the Charcot group (from 39.1 to 38.5 V) (p = 0.946), but a significantly worsened sensitivity in the control group (from 25.1 to 38.9 V) (p = 0.002). In conclusion, we found that any differences in somatic or cardial autonomic neuropathy present at baseline had disappeared at follow-up after 8.5 years.

Dane K. Wukich - One of the best experts on this subject based on the ideXlab platform.

  • Orthopaedic surgery and the diabetic Charcot Foot.
    The Medical clinics of North America, 2013
    Co-Authors: Wei Shen, Dane K. Wukich
    Abstract:

    Over the past two decades, a gradual trend toward more aggressive management of diabetic Charcot neuroarthropathy has occurred, mainly due to improved understanding of the pathophysiology and advances in surgical techniques. Although the mainstay of diabetic Charcot Foot management is still nonoperative, surgical reconstruction using internal and external fixation techniques is indicated in patients with progressive deformity, instability, recurrent ulceration, and impending compromise of the soft tissue envelope. The ultimate goal of treatment, whether nonsurgical or surgical, is to achieve a stable, plantigrade Foot that can be accommodated with appropriate shoe wear and orthotics. Various surgical procedures are described.

  • Charcot Foot: a surgical algorithm.
    Instructional course lectures, 2012
    Co-Authors: Michael S. Pinzur, Vincent James Sammarco, Dane K. Wukich
    Abstract:

    The historic treatment of Charcot Foot has entailed non-weight-bearing immobilization during the acute active phase, followed by longitudinal management with accommodative bracing. This treatment plan yields poor outcomes, even in cases classified as successful. An appreciation of poor outcomes convinced experts to attempt correction of the resultant deformities. Early attempts at surgical correction of the acquired deformities in patients with medical comorbidities were complicated by infection, wound failure, and mechanical loss of correction. New surgical techniques have been designed to obtain and maintain correction and minimize the risks for complications and poor outcomes in this complex patient population.

Robert G. Frykberg - One of the best experts on this subject based on the ideXlab platform.

  • The Diabetic Charcot Foot
    Contemporary Diabetes, 2018
    Co-Authors: Lee C. Rogers, Robert G. Frykberg
    Abstract:

    The diabetic Charcot Foot is a potentially limb-threatening deformity associated with peripheral neuropathy and concomitant injury. Often the precipitating injury is fairly minor, but unrecognized due to the underlying peripheral sensory neuropathy. With existing loss of protective sensation the neuropathic individual continues to walk on the injured extremity causing progressive inflammation with varying degrees of bone and joint pathology. Severe deformity can ensue that predisposes to ulceration, infection, and potential amputation. It is therefore critical to diagnose this condition early in its natural history to prevent progressive Foot or ankle deformity and instability.

  • the Charcot Foot
    Medical Clinics of North America, 2013
    Co-Authors: Lee C. Rogers, Robert G. Frykberg
    Abstract:

    The diabetic Charcot Foot is rare, but a life-changing event affecting quality of life, and it risks amputation of the limb. There is no high quality evidence base governing treatment, causing clinicians to rely on low-quality, underpowered studies and expert opinion. However, CN is a treatable condition and, with lifestyle modifications and proper Footwear, it does not shorten the life span of those afflicted.

  • The Charcot Foot.
    The Medical clinics of North America, 2013
    Co-Authors: Lee C. Rogers, Robert G. Frykberg
    Abstract:

    The Charcot Foot or Charcot neuroarthropathy (CN) is a rare, but complex and often misdiagnosed complication of diseases causing peripheral neuropathy, like diabetes. Early recognition and treatment can prevent complications like ulcers and amputations. This article provides a review of the current evidence base and offers a pathway for treatment.

  • The Charcot Foot in Diabetes
    Diabetes care, 2011
    Co-Authors: Lee C. Rogers, Georges Ha Van, Michael Edmonds, William Jeffcoate, Robert G. Frykberg, David Armstrong, Andrew J.m. Boulton, Agnes Hartemann, Frances L. Game, Alexandra Jirkovská
    Abstract:

    The diabetic Charcot Foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot Foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity.

  • Epidemiology of the Charcot Foot
    Clinics in podiatric medicine and surgery, 2008
    Co-Authors: Robert G. Frykberg, Ronald J. Belczyk
    Abstract:

    The Charcot Foot (osteoarthropathy) is a significant lower extremity complication of diabetes mellitus that can result in significant deformity, ulceration, and subsequent limb loss. A result of even unrecognized trauma to an insensitive Foot, continued weight bearing on the injured Foot promotes the evolution of the disorder that is often diagnosed only after significant deformity has occurred. Although this entity is considered a rare complication of the diabetic population, it has profound implications for those persons affected. Greater awareness of the frequency, distribution, determinants, and natural history of Charcot Foot can help clinicians establish an earlier diagnosis and institute effective treatment before the onset of limb-threatening deformity.