Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 16 , ISSUE 2 ( May-August, 2021 ) > List of Articles

Original Article

Correction of Foot Deformities from Charcot Arthropathy with the Taylor Spatial Frame: A 7–14-year Follow-up

Om Lahoti, Naveen Abhishetty, Sandesh Shetty

Keywords : Charcot neuroarthropathy, Circular frame, Cohort study, Diabetic foot ulcers, Forefoot butt 6 × 6, Long bone TSF module, Rocker-bottom foot deformity, Taylor spatial frame

Citation Information : Lahoti O, Abhishetty N, Shetty S. Correction of Foot Deformities from Charcot Arthropathy with the Taylor Spatial Frame: A 7–14-year Follow-up. 2021; 16 (2):96-101.

DOI: 10.5005/jp-journals-10080-1525

License: CC BY-NC-SA 4.0

Published Online: 27-10-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Charcot arthropathy related foot and ankle deformities are a serious challenge. Surgical treatment of these deformities is now well established. Conventional surgical treatment includes extensive surgical exposure, excision of bone, acute correction and internal fixation, which is not always appropriate in presence of active ulceration, infection and poor bone quality. A minimally invasive approach to osteotomies and gradual correction of deformities using a circular frame are proving helpful in minimizing the complications. Taylor Spatial Frame (TSF) hexapod with its various modules is well suited for a range of foot and ankle deformities. We have advocated minimally invasive targeted hind and mid foot osteotomies and gradual correction with Taylor Spatial Frame (TSF) in 10 patients with recurrent ulceration and deformity. There are 2 female and 8 male patients in this cohort. Appropriate TSF module was chosen for each patient– a long bone module for ankle and hindfoot deformities (4 patients) and a forefoot 6x6 butt frame (6 patients) for foot deformities. An osteotomy through the midfoot was performed in all chronic stable foot deformity cases. In the ankle and hindfoot deformities, a combination of soft tissue distraction correction of equinus and acute correction of hindfoot deformity through a calcaneal osteotomy, were used. Our outcome measures are complete healing of the ulcers and resolution of infection, clinically plantigrade foot and ability to wear regular or diabetic footwear. Complications included eight episodes of pin infection that responded to oral antibiotics only and two pin breakages. We achieved ulcer and infection free plantigrade feet that fit in to regular or diabetic footwear in 9 out of 10 patients. 9 patients remain ulcer and infection free at a minimum of 7 years and maximum of 14 years follow up. Taylor Spatial Frame treatment provides an alternative to conventional surgery in high-risk complex Charcot neuroarthropathy foot and ankle deformities.


PDF Share
  1. McKenzie P. Diabetes footcare project 1: pathway development. North West Coast Strategic Clinical Networks, 2017.
  2. Armstrong DG, Wrobel J, Robbins JM. Guest editorial: are diabetes-related wounds and amputations worse than cancer? Int Wound J 2007;4(4):286–287. DOI: 10.1111/j.1742-481X.2007.00392.x.
  3. Paisey RB, Abbott A, Paisey CF, et al. Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18-year study. Diabet Med 2019;36(11):1424–1430. DOI: 10.1111/dme.14045.
  4. La Fontaine J, Lavery L, Jude E. Current concepts of Charcot foot in diabetic patients. Foot 2016;26:7–14. DOI: 10.1016/j.foot.2015.11.001.
  5. Louwerens JWK. Reconstruction of the medial column of the foot using plate fixation. Fuß Sprunggelenk 2016;14(4):212–218. DOI: 10.1016/j.fuspru.2016.08.009.
  6. Richman J, Cota A, Weinfeld S. Intramedullary nailing and external ring fixation for tibiotalocalcaneal arthrodesis in charcot arthropathy. Foot Ankle Int 2017;38(2):149–152. DOI: 10.1177/1071100716671884.
  7. Yousry AH, Abdalhady AM. Management of diabetic neuropathic ankle arthropathy by arthrodesis using an Ilizarov frame. Acta Orthop Belg 2010;76(6):821–826. Available at: https://pubmed.ncbi.nlm.nih.gov/21302582/
  8. El-Gafary KA, Mostafa KM, Al-Adly WY. The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame: early results. J Bone Joint Surg Br 2009;91(10):1322–1325. DOI: 10.1302/0301-620X.91B10.22431.
  9. Kimawi AA, Snyder RJ, Cala MA, et al. When traditional offloading is not an option, could an external fixator be a solution? A case report. Wounds 2017;29(2):46–50. Available at: https://pubmed.ncbi.nlm.nih.gov/28272013/
  10. Pinzur MS. Static ring fixation for nonplantigrade charcot midfoot deformity. Oper Tech Orthop 2008;18(4):287–292. DOI 10.1053/j.oto.2009.01.006.
  11. Lamm BM, Gottlieb HD, Paley D. A two-stage percutaneous approach to charcot diabetic foot reconstruction. J Foot Ankle Surg 2010;49(6):517–522. DOI: 10.1053/j.jfas.2010.07.014.
  12. Ramanujam CL, Zgonis T. An overview of internal and external fixation methods for the diabetic charcot foot and ankle. Clin Podiatr Med Surg 2017;34(1):25–31. DOI: 10.1016/j.cpm.2016.07.004.
  13. Roukis TS, Zgonis T. The management of acute charcot fracture-dislocations with the Taylor spatial external fixation system. Clin Podiatr Med Surg 2006;23(2):467–483. DOI: 10.1016/j.cpm.2006.01.008.
  14. Shawn C. Standard MJEH, Conway JD, et al. The art of limb alignment: chapter 11. In: Foot and ankle axis planning: frontal, sagittal, and transverse planes, 7th ed. Baltimore: Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2018. p. 221.
  15. Belczyk RJ, Wukich DK. Correction of rockerbottom deformity using the butt frame. Oper Tech Orthop 2006;16(1):23–31. DOI 10.1053/j.oto.2006.02.005.
  16. Frykberg RG, Wukich DK, Kavarthapu V, et al. Surgery for the diabetic foot: a key component of care. Diabetes Metab Res Rev 2020;36(Suppl 1):e3251. DOI: 10.1002/dmrr.3251.
  17. Zgonis T, Stapleton JJ, Jeffries LC, et al. Surgical treatment of charcot neuroarthropathy. AORN J 2008;87(5):971–990. DOI: 10.1016/j.aorn.2008.03.002.
  18. Pinzur MS, Schiff AP. Deformity and clinical outcomes following operative correction of charcot foot: a new classification with implications for treatment. Foot Ankle Int 2018;39(3):265–270. DOI: 10.1177/1071100717742371.
  19. Pinzur MS, Gil J, Belmares J. Treatment of osteomyelitis in Charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation. Foot Ankle Int 2012;33(12):1069–1074. DOI: 10.3113/FAI.2012.1069.
  20. Farber DC, Juliano PJ, Cavanagh PR, et al. Single stage correction with external fixation of the ulcerated foot in individuals with Charcot neuroarthropathy. Foot Ankle Int 2002;23(2):130–134. DOI: 10.1177/107110070202300209.
  21. Grant WP, Garcia-Lavin SE, Sabo RT, et al. A retrospective analysis of 50 consecutive charcot diabetic salvage reconstructions. J Foot Ankle Surg 2009;48(1):30–38. DOI: 10.1053/j.jfas.2008.10.004.
  22. Stapleton JJ, Zgonis T. Surgical reconstruction of the diabetic charcot foot: internal, external or combined fixation? Clin Podiatr Med Surg 2012;29(3):425–433. DOI: 10.1016/j.cpm.2012.04.003.
  23. Cooper PS. Application of external fixators for management of charcot deformities of the foot and ankle. Semin Vasc Surg 2003;16(1):67–78. DOI: 10.1053/svas.2003.50007.
  24. Paley D. Principles of deformity correction, 1st ed. New York: Springer, 2002.
  25. Floerkemeier T, Stukenborg-Colsman C, Windhagen H, et al. Correction of severe foot deformities using the Taylor spatial frame. Foot Ankle Int 2011;32(2):176–182. DOI: 10.3113/FAI.2011.0176.
  26. Waizy H, Windhagen H, Stukenborg-Colsman C, et al. Taylor spatial frame in severe foot deformities using double osteotomy: technical approach and primary results. Int Orthop 2011;35(10):1489–1495. DOI: 10.1007/s00264-011-1269-8.
  27. Eidelman M, Katzman A. Treatment of arthrogrypotic foot deformities with the Taylor spatial frame. J Pediatr Orthop 2011;31(4):429–434. DOI: 10.1097/BPO.0b013e3182172392.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.