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 accommodative treatment. There is increased current interest in operative correction of the acquired deformity with the stated goals of achieving both the traditional goals of resolution of infection and limb salvage as well as the desire to improve quality of life. The Short Musculoskeletal Functional Assessment (SMFA) outcomes instrument appears to be a valid tool for evaluating this complex patient population. METHODS: Twenty-five consecutive patients undergoing operative reconstruction for nonplantigrade midtarsal Charcot foot arthropathy completed the SMFA patient-reported outcomes instrument prior to surgery, with 24 completing it at 1 year following the surgery. One patient died during the year following surgery from unrelated causes. RESULTS: There was an 11.5-point (95% confidence interval [CI]: -19.7 to -3.2) decrease in the standardized functional index ( P = .01). Similarly, there was a 12.4-point (95% CI: -22.5 to -2.3) decrease in the standardized bother index ( P = .02). The standardized daily activity index demonstrated a 19.6-point decrease (95% CI: -30.5 to -8.6, P = .002), and there was a 14.7-point (95% CI: -24.1 to -5.3) decrease in the standardized emotion index ( P = .004). There was no meaningful change in the standardized arm/hand index ( P = .81). CONCLUSION: The results of this investigation demonstrate that successful operative reconstruction of midtarsal Charcot foot arthropathy improved quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity to the modern interest in operative correction to allow the use of commercially available therapeutic footwear. LEVEL OF EVIDENCE: Level IV, case series.
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 accommodative treatment. There is increased current interest in operative correction of the acquired deformity with the stated goals of achieving both the traditional goals of resolution of infection and limb salvage as well as the desire to improve quality of life. The Short Musculoskeletal Functional Assessment (SMFA) outcomes instrument appears to be a valid tool for evaluating this complex patient population. METHODS: Twenty-five consecutive patients undergoing operative reconstruction for nonplantigrade midtarsal Charcot foot arthropathy completed the SMFA patient-reported outcomes instrument prior to surgery, with 24 completing it at 1 year following the surgery. One patient died during the year following surgery from unrelated causes. RESULTS: There was an 11.5-point (95% confidence interval [CI]: -19.7 to -3.2) decrease in the standardized functional index ( P = .01). Similarly, there was a 12.4-point (95% CI: -22.5 to -2.3) decrease in the standardized bother index ( P = .02). The standardized daily activity index demonstrated a 19.6-point decrease (95% CI: -30.5 to -8.6, P = .002), and there was a 14.7-point (95% CI: -24.1 to -5.3) decrease in the standardized emotion index ( P = .004). There was no meaningful change in the standardized arm/hand index ( P = .81). CONCLUSION: The results of this investigation demonstrate that successful operative reconstruction of midtarsal Charcot foot arthropathy improved quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity to the modern interest in operative correction to allow the use of commercially available therapeutic footwear. LEVEL OF EVIDENCE: Level IV, case series.
Authors: Rachel H Albright; Robert M Joseph; Dane K Wukich; David G Armstrong; Adam E Fleischer Journal: Clin Orthop Relat Res Date: 2020-12 Impact factor: 4.755