The Journal of Bone and Joint Surgery (American). 2009;91:80-91.
doi:10.2106/JBJS.G.01629
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy

V. James Sammarco, MD1, G. James Sammarco, MD1, Earl W. Walker, Jr., MD2 and Ronald P. Guiao, MD3

1 Cincinnati SportsMedicine and Orthopaedic Center, 10663 Montgomery Road, Cincinnati, OH 45242. E-mail address for V.J. Sammarco: vjsammarco{at}csmoc.com
2 Carolina Orthopaedic Associates, 503 East Parker Road, Morganton, NC 28655
3 Department of Orthopaedics, University of Wisconsin, One South Park Street, Madison, WI 53715

Investigation performed at the Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, Ohio

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A video supplement related to the subject of this article has been developed by the American Academy of Orthopaedic Surgeons and JBJS and is available for viewing in the video library of the JBJS website, www.jbjs.org. To obtain a copy of the video, contact the AAOS at 800-626-6726 or go to their website, www.aaos.org, and click on Educational Resources Catalog.

Background: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique.

Methods: A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed. Bone resection and/or osteotomy were required to reduce deformity. Axially placed intramedullary screws, inserted either antegrade or retrograde across the arthrodesis sites, were used to restore the longitudinal arch. Radiographic measurements were recorded preoperatively, immediately postoperatively, and at the time of the last follow-up and were analyzed in order to assess the amount and maintenance of correction.

Results: Patients were evaluated clinically and radiographically at an average of fifty-two months. Complete osseous union was achieved in sixteen of the twenty-two patients, at an average of 5.8 months. There were five partial unions in which a single joint did not unite in an otherwise stable foot. There was one nonunion, with recurrence of deformity. All patients returned to an independent functional ambulatory status within 9.5 months. Weight-bearing radiographs showed the talar-first metatarsal angle, the talar declination angle, and the calcaneal-fifth metatarsal angle to have improved significantly and to have been corrected to nearly normal values by the surgery. All measurements remained significantly improved, as compared with the preoperative values, at the time of final follow-up. There were no recurrent dislocations. Three patients had a recurrent plantar ulcer at the metatarsophalangeal joint that required additional surgery. There were eight cases of hardware failure.

Conclusions: Open reduction and arthrodesis with use of multiple axially placed intramedullary screws for the surgical correction of neuropathic midfoot collapse provides a reliable stable construct to achieve and maintain correction of the deformity.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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