X-ray measures predict ulcers in midfoot charcots

NewsBot · Jun 14, 2008

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Radiographic measures as a predictor of ulcer formation in diabetic charcot midfoot.
Bevan WP, Tomlinson MP.
Foot Ankle Int. 2008 Jun;29(6):568-73.

BACKGROUND: Plantar midfoot ulceration in diabetic patients with midfoot Charcot neuroarthropathy is a risk factor for infection that can require amputation. The aim of this study was to determine a simple radiographic predictor of the individual risk of subsequent ulcer formation in this group of patients.

MATERIALS AND METHODS: A retrospective review of all patients seen at our institution between January 1998 and July 2004 with diabetic Charcot neuroarthropathy was performed. Exclusion criteria were previous reconstructive foot surgery, absence of weightbearing foot radiographs and absent pedal pulses. Patient charts were reviewed for demographics, diabetic co-morbidities, and presence of midfoot skin pathology (plantar callus and/or ulceration). Weightbearing anteroposterior and lateral radiographs were assessed using standard measurements.

RESULTS: Nineteen patients with radiographs of 24 feet were included. Fifty-eight percent were female, and the mean age was 54 (SD +/- 13) years. Ninety-five percent had type II diabetes mellitus, and the median duration of illness was 20 (range, 14 to 25) years. Midfoot ulceration and callus formation were seen in 6 (25%) and 2 feet, respectively. When radiographic measures of feet with and without midfoot skin pathology were compared, the lateral talar-first metatarsal angle was significantly associated with skin pathology (p < 0.001).

CONCLUSION: The lateral talar-first metatarsal angle measured on weightbearing radiographs is a simple means of monitoring patients' risk of development of midfoot ulceration. Only patients with a lateral talar-first metatarsal angle of greater than -27 degrees had an ulcer. This may be a clinically useful threshold for increased risk of the development of ulceration in midfoot diabetic neuroarthropathy.
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Admin2 · Jun 16, 2008

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NewsBot · May 7, 2018

Reliability of the Measurement of Cuboid Height in Midfoot Charcot Neuroarthropathy
Shyam Sheth et al
JFAS; Article in Press

Cuboid height is a quantitative radiographic measurement of the relationship of the inferior cuboid to the plantar osseous plane of the lateral column of the foot and might be associated with poor clinical outcomes in patients with midfoot Charcot neuroarthropathy. We evaluated the reliability of the cuboid height measured by a group of foot and ankle surgeons on subjects with midfoot Charcot neuroarthropathy. Ten board-certified foot and ankle surgeons, 10 residents, and 10 medical students measured the cuboid height on 11 lateral weightbearing radiographic projections of subjects with midfoot Charcot neuroarthropathy. Cuboid height measurements were grouped categorically with calculation of an intraclass correlation coefficient (ICC). Ten unique images were used, with 1 repeated image to provide a measure of intrarater agreement. The overall measure of reliability of cuboid height measurement was an ICC of 0.997. Specifically, the ICC was 0.987 for surgeons, 0.992 for residents, and 0.989 for students. Participants were in agreement with the repeated measure in 24 (80.0%) of 30 cases. Specifically, each group (surgeons, residents, and students) were each in agreement for 8 (80.0%) of 10 repeated measurements. In conclusion, these results demonstrate excellent reliability for radiographic measurement of cuboid height on subjects with midfoot Charcot neuroarthropathy. To the best of our knowledge, this is the first investigation to provide a measure of reliability for this radiographic outcome, which is potentially related to clinical outcomes in the evaluation and treatment of this challenging patient cohort.
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