Diabetic Neuromuscular Foot and Ankle Deformities Reconstructed with Long-Segment and Rigid Internal Fixation Lead to Optimal Outcomes

Category: Hindfoot; Diabetes Introduction/Purpose: Severe neuromuscular foot and ankle deformities can develop due to progressive muscle imbalance on the background of diabetic peripheral neuropathy not related to Charcot neurarthopathy (CN). Our unit has a concentrated experience of treating severe deformities arising from diabetic CN using the principles of durable, long segment and rigid internal fixation with optimal opposition. We present a series of diabetic neuromuscular deformities reconstructed using these principles. Methods: This was a single centre, retrospective study including 20 patients who had diabetic neuromuscular foot and ankle deformities, in the absence of CN, operated on between October 2009 to December 2021. The deformity was corrected using wedge bone resections and tendon balancing procedures, followed by fixation. Data was collected on clinical and radiographic outcomes with a minimum 1-year follow-up. Results: 20 cases were included with a mean age of 53.7 years and follow-up of 42.1 months (range 12-94). 9 patients had Type 1 and 11 patients had Type 2 diabetes. Mean pre-operative HbA1c was 8.1. 15 had pre-operative ulceration. There were 6 isolated hindfoot, 2 midfoot and 12 combined hindfoot and midfoot deformities. All pre-operative ulcers healed and all achieved a stable and plantigrade foot. Full bone union was noted in 1/2 midfoot, 5/6 hindfoot and 10/12 combined corrections 12 months post-surgery. 15/20 patients returned to full weight bearing, 12 of whom were in surgical shoes. Metal work failure was noted in 5 patients. No recurrent or new ulcers in the reconstructed areas were noted and no patients developed Charcot activation during the post-operative period. Conclusion: Reconstruction of neuromuscular foot and ankle deformities due to diabetic peripheral neuropathy using principles of durable, long-segment and rigid internal fixation with bone opposition provided good radiological and clinical outcomes with good bone fusion rates, low complications, no ulcer recurrence and no Charcot activation.