The medial column Synthes Midfoot Fusion Bolt is associated with unacceptable rates of failure in corrective fusion for Charcot deformity RESULTS FROM A CONSECUTIVE CASE SERIES

Charcot neuro-osteoarthropathy (CN) of the midfoot presents a major reconstructive challenge for the foot and ankle surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and recommended for patients who have a deformity of the medial column of the foot due to CN. We present the results from the first nine patients (ten feet) on which we attempted to perform fusion of the medial column using this bolt. Six feet had concurrent hindfoot fusion using a retrograde nail. Satisfactory correction of deformity of the medial column was achieved in all patients. The mean correction of calcaneal pitch was from 6 degrees (-15 degrees to +18 degrees) pre-operatively to 16 degrees (7 degrees to 23 degrees) post-operatively; the mean Meary angle from 26 degrees (3 degrees to 46 degrees) to 1 degrees (1 degrees to 2 degrees); and the mean talometatarsal angle on dorsoplantar radiographs from 27 degrees (1 degrees to 48 degrees) to 1 degrees (1 degrees to 3 degrees). However, in all but two feet, at least one joint failed to fuse. The bolt migrated in six feet, all of which showed progressive radiographic osteolysis, which was considered to indicate loosening. Four of these feet have undergone a revision procedure, with good radiological evidence of fusion. The medial column bolt provided satisfactory correction of the deformity but failed to provide adequate fixation for fusion in CN deformities in the foot. In its present form, we cannot recommend the routine use of this bolt.