Andreas Wagner1, Renée Fuhrmann, Andreas Roth. 1. Oberarzt am Lehrstuhl für Orthopädie, Waldkrankenhaus Rudolf Elle gGmbH, Klosterlausnitzer Strasse 81, 07607 Eisenberg, Germany. XAndreasWagnerX@AOL.com
Abstract
THE PROBLEM: First patient: neuropathic osteoarthropathy with severely deformed foot, plantar ulceration and recurrent purulent infections. Second patient: diabetic osteoarthropathy with pathologic fracture. CLINICAL FINDINGS: First patient: 50-year-old man with hereditary sensory and motor neuropathy, plantar ulceration, equinus of the hindfoot, and extensive destruction of all bones of the foot. Recurrent infections necessitated repeated surgical interventions during the last 7 years. At the time of admission purulent infection of the foot. Healing after debridement including a resection of metatarsal bones and part of sequestrated bones of the foot. Patient was left with a severe equinus of the hindfoot. TREATMENT OPTIONS: Orthopedic shoes with or without below-knee orthesis. Lengthening of the Achilles tendon and plantar alignment of the calcaneus. Arthrodesis of the hindfoot. Below-knee amputation, if necessary as a primary procedure to combat infection. THE SOLUTION: Arthrodesis of the hindfoot after realignment; an amputation of the foot was refused. SURGICAL TECHNIQUE: Two-stage procedure: treatment of infection followed by astragalectomy and tibiocalcaneal arthrodesis achieved with cancellous lag screws. Bridging of the area of resection with a segment of the fibula. RESULT: Bony fusion and full load bearing in an orthopedic shoe after 3 months. Recurrence of ulcerations after 20 and 27 months due to wear of ill-fitting shoes. The accompanying purulent process forced the authors to resort to a below-knee amputation and fitting of a prosthesis. Second patient: of this patient only radiographs with a retrograde introduced intramedullary nail are shown.
THE PROBLEM: First patient: neuropathic osteoarthropathy with severely deformed foot, plantar ulceration and recurrent purulent infections. Second patient: diabetic osteoarthropathy with pathologic fracture. CLINICAL FINDINGS: First patient: 50-year-old man with hereditary sensory and motor neuropathy, plantar ulceration, equinus of the hindfoot, and extensive destruction of all bones of the foot. Recurrent infections necessitated repeated surgical interventions during the last 7 years. At the time of admission purulent infection of the foot. Healing after debridement including a resection of metatarsal bones and part of sequestrated bones of the foot. Patient was left with a severe equinus of the hindfoot. TREATMENT OPTIONS: Orthopedic shoes with or without below-knee orthesis. Lengthening of the Achilles tendon and plantar alignment of the calcaneus. Arthrodesis of the hindfoot. Below-knee amputation, if necessary as a primary procedure to combat infection. THE SOLUTION: Arthrodesis of the hindfoot after realignment; an amputation of the foot was refused. SURGICAL TECHNIQUE: Two-stage procedure: treatment of infection followed by astragalectomy and tibiocalcaneal arthrodesis achieved with cancellous lag screws. Bridging of the area of resection with a segment of the fibula. RESULT: Bony fusion and full load bearing in an orthopedic shoe after 3 months. Recurrence of ulcerations after 20 and 27 months due to wear of ill-fitting shoes. The accompanying purulent process forced the authors to resort to a below-knee amputation and fitting of a prosthesis. Second patient: of this patient only radiographs with a retrograde introduced intramedullary nail are shown.