MANAGEMENT OF MIDFOOT DIABETIC NEUROARTHROPATHY

被引：94

作者：

MYERSON, MS ^{[1
]}

HENDERSON, MR ^{[1
]}

SAXBY, T ^{[1
]}

SHORT, KW ^{[1
]}

机构：

[1] UNION MEM HOSP,BALTIMORE,MD 21218

来源：

FOOT & ANKLE INTERNATIONAL | 1994年 / 15卷 / 05期

关键词：

D O I：

10.1177/107110079401500502

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Between 1986 and 1990, we treated 68 patients with diabetes and neuroarthropathy of the midfoot, 21 of whom had bilateral involvement. Patients were managed according to a strict protocol defined by activity of the neuroarthropathy, instability, ulceration, infection, and ischemia. Initial management of acute neuroarthropathy (18 feet) was open reduction and arthrodesis (8), a total-contact cast or brace (9), and amputation (1). All patients with subacute neuroarthropathy (30 feet) were initially treated in a total contact cast. Four of these feet subsequently required amputation, two required arthrodesis, and one required exostectomy. For chronic neuroarthropathy (41 feet), a total-contact cast or a molded orthotic insert with or without bracing was used initially in all feet. Subsequent surgical salvage for this group included arthrodesis (9), plantar exostectomy (6), amputation (2), and abscess drainage (2). Four patients died during this treatment period and 64 patients (85 feet) were evaluated at a mean interval of 3 years (range 1-6 years) after initiation of treatment. This treatment program was found to be successful in 82 of 85 feet treated.

引用

页码：233 / 241

页数：9

共 18 条

[1]

Brodsky J.W., Wagner F.W., Kwong P.K., Et al., Patterns of breakdown in the Charcot tarsus of diabetes and relation to treatment, Orthop. Trans., 2, (1987)

[2]

Eichenholtz S.N., Charcot Joints, (1966)

[3]

Goldner M.G., The fate of the second leg in the diabetic amputee, Diabetes, 9, (1960)

[4]

Griffiths H.J., Diabetic osteopathy, Orthopedics, 8, 3, pp. 401-406, (1985)

[5]

Hoar C.S., Torres J., Evaluation of below-the-knee amputation in the treatment of diabetic gangrene, N. Engl. J. Med., 266, pp. 440-443, (1962)

[6]

Holewski J.J., Moss K.M., Stess R.M., Graf P.M., Gunfeld C., Prevalence of foot pathology and lower extremity complications in a diabetic outpatient clinic, J. Rehabil. Res. Dev., 26, 3, pp. 35-44, (1989)

[7]

Kristiansen B., Ankle and foot fractures in diabetics provoking neuropathic joint changes, Acta Orthop. Scand., 51, pp. 975-979, (1980)

[8]

Lesko P., Maurer R.C., Talonavicular dislocations and midfoot arthropathy in neuropathic diabetic feet, Natural course and principles of treatment. Clin. Orthop., 240, pp. 226-231, (1989)

[9]

Lippman H.I., Perotto A., Farrar R., The neuropathic foot of the diabetic, Bull. N.Y. Acad. Med., 52, pp. 1159-1178, (1976)

[10]

McKittrick L.S., McKittrick J.B., Risley T.S., Transmetatarsal amputation for infection of gangrene in patients with diabetes mellitus, Ann. Surg., 130, (1949)

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