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다국어 초록 (Multilingual Abstract)

The article by Kim et al.1) offers important and interesting information on the management of midfoot Charcot arthropathy. This manuscript presents satisfactory results of a conservative treatment without restriction of daily living activities. However, much of the literature manifests other types of treatment for this pathology. The aim of this letter is to provide a short review on the treatment of midfoot Charcot arthropathy with latest evidence.

Botek et al.2) stated that offloading is the key to treatment because it gives the time to heal and arrest the progressive tissue damage and deformities. This should remain until the inflammation disappears (3 to 12 months, approximately). However, nowadays surgical correction of the Charcot deformity has good supporting evidence. The different techniques include exostectomies, muscle flaps, arthrodesis with internal or external fixation. The circular external fixation is considered to be biomechanically superior to the others. Indications for surgical intervention are unstable joints, nonhealing or infected ulcers, equinus deformities, and unbraceable deformities.

A case report by Higgins et al.3) also presents a 58-year-old diabetic man with an acute Charcot arthropathy, in which offloading was essential for the treatment of the foot. The authors demonstrated that surgery is not useful in acute cases; however, the surgical procedures mentioned previously have demonstrated variable success in the treatment of deformities in chronic Charcot arthropathy. Therefore, the initial treatment of this patient was immobilization with total contact casting, which is the gold standard in acute cases.

The offloading therapy is critical in the initial treatment of Charcot arthropathy because it gives the chance of healing properly without weakening deformities and preserves longitudinal arch; however, there are cases that are not successful. For these cases, Rosskopf et al.4) recommended stabilization with the Ilizarov external fixator (or ring fixator) frame as an alternative treatment option for offloading in patients with severe deformity or after removal of osteomyelitic bone fragments.

Raspovic et al.5) stated that surgical reconstruction usually consists of a combination of tendon releases/lengthening, fusions, and osteotomies as needed to address the deformity. The goal is to give stability so the patient can achieve free ambulation. One of the surgical techniques is to release the contracted soft tissue to correct deformity. This is done percutaneously or open via three small incisions. On the other hand, the intramedullary fixation of the medial and lateral columns for midfoot Charcot arthropathy reconstruction allows control of the transverse arch of the foot and to this a fusion of the subtalar joint can be added in order to limit frontal and transverse plane torsion and achieve greater stability. However, internal fixation is not recommended in cases of infection.

Charcot arthropathy is a severe complication of diabetes mellitus that mainly affects the patient's quality of life. Ambulation is severely limited, so the periodic control of this type of patients is an essential part of reporting early findings of arthropathy, and thus, avoiding invasive interventions that harm rather than benefit the evolution of the disease.

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참고문헌 (Reference)

1 Rosskopf AB, "The Charcot foot : a pictorial review" 10 (10): 77-, 2019

2 Kim YK, "Sarcopenia increases the risk for mortality in patients who undergo amputation for diabetic foot" 11 : 32-, 2018

3 You Keun Kim, "Results of Simple Conservative Treatment of Midfoot Charcot Arthropathy" 대한정형외과학회 11 (11): 459-465, 2019

4 한혁수, "Relations between Long-term Glycemic Control and Postoperative Wound and Infectious Complications after Total Knee Arthroplasty in Type 2 Diabetics" 대한정형외과학회 5 (5): 118-123, 2013

5 Assal M, "Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy" 91 (91): 812-820, 2009

6 Raspovic KM, "Optimizing results in diabetic Charcot reconstruction" 36 (36): 469-481, 2019

7 Sammarco VJ, "Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy" 91 (91): 80-91, 2009

8 Nikolaos Papanas, "Etiology, pathophysiology and classifications of the diabetic Charcot foot" Informa UK Limited 4 (4): 20872-, 2013

9 Botek G, "Charcot neuroarthropathy advances : understanding pathogenesis and medical and surgical management" 36 (36): 663-684, 2019

10 Botek G, "Charcot neuroarthropathy ad-vances : understanding pathogenesis and medical and surgical management" 36 (36): 663-684, 2019