Abstract
Background: To identify differences in radiographic outcomes in weight-bearing lateral X-ray to predict the probability of ulceration in patients with midfoot Charcot neuroarthropathy (CN) differentiated by lateral and medial column deformities. Methods: Thirty-five patients who suffered from CN midfoot deformity participated in this 1 year prospective study in a specialized diabetic foot unit. Lateral talar-first metatarsal angle, calcaneal pitch, and cuboid height were performed by digital radiographs in the weight-bearing lateral view. Patients were followed up for 1 year or until an ulcer ulceration event occurred in the midfoot region. Results: ROC analyses showed that all patients with medial pattern deformity that developed a midfoot ulcer had a lateral talar-first metatarsal angle greater (negative) than −27.5 degrees (°). All patients with lateral pattern deformity that developed a midfoot ulcer had a calcaneal pitch greater (more negative) than −5° and a cuboid height greater (more negative) than −1.5°. Conclusions: Lateral talar-first metatarsal angle was the greatest predictor of midfoot ulceration, with greater than −27.5° measurement correlating with ulceration occurrence in patients with medial deformity. Calcaneal pitch and cuboid height were the greatest predictors of midfoot ulceration with greater than −5 and −1.5°, respectively in patients with CN lateral deformity.
Highlights
Thirty-five patients at risk for foot ulceration and who suffered from Charcot neuroarthropathy (CN) midfoot deformity participated in this 1 year prospective study in a specialized diabetic foot unit between December 2018 and January 2021
Regarding baseline characteristics and CN duration before inclusion, we did not find any difference between groups
Using ROC analyses, we found that all patients with medial pattern deformity that developed a midfoot ulcer had a lateral talar-first metatarsal angle greater than −27.5 degrees (Sensitivity = 100; Specificity = 100%)
Summary
Charcot neuroarthropathy (CN) is a progressive, noninfectious, destructive inflammatory process of the foot and ankle, leading to severe deformities and further risk of amputation and death [1,2], with diabetes and polyneuropathy being the leading causes [3,4,5].According to the anatomical classification [5], midfoot deformity is the most common location, accounting for up to 60% of patients with CN diagnosis [6,7,8].Midfoot Charcot patients are characterized by bony prominences in the medial or lateral aspect of the foot, increasing plantar pressures and predisposing them to ulcer occurrence in the midfoot [9]. Lateral talar-first metatarsal angle, calcaneal pitch, and cuboid height were performed by digital radiographs in the weight-bearing lateral view. Results: ROC analyses showed that all patients with medial pattern deformity that developed a midfoot ulcer had a lateral talar-first metatarsal angle greater (negative) than −27.5 degrees (◦ ). All patients with lateral pattern deformity that developed a midfoot ulcer had a calcaneal pitch greater (more negative) than −5◦ and a cuboid height greater (more negative) than −1.5◦. Conclusions: Lateral talar-first metatarsal angle was the greatest predictor of midfoot ulceration, with greater than −27.5◦ measurement correlating with ulceration occurrence in patients with medial deformity. Calcaneal pitch and cuboid height were the greatest predictors of midfoot ulceration with greater than −5 and −1.5◦ , respectively in patients with CN lateral deformity
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