Patient-Reported Functional Outcomes Following Charcot Foot Reconstruction

Research Type: Level 2 - Prospective comparative study, Meta-analysis of Level 2 studies or Level 1 studies with inconsistent results Introduction/Purpose: Reconstruction of diabetes-associated Charcot foot arthropathy has been shown to improve quality of life. The purpose of this study was to quantify functional outcomes after Charcot foot reconstruction utilizing various domains of the Patient-Reported Outcomes Measurement Information System (PROMIS) and the Foot and Ankle Disability Index (FADI), which have not been previously reported for this population. Methods: This was a retrospective study of patients with diabetes-associated Charcot foot arthropathy who underwent surgical reconstruction using a circular external fixator between 2022 and 2023. PROMs included were the Foot and Ankle Disability Index (FADI), PROMIS Global Health (PROMIS-GH) with mental and physical health subscale components, PROMIS Pain Interference (PROMIS-PI), and PROMIS Physical Function (PROMIS-PF). Questionnaires were obtained preoperatively and at regular postoperative intervals (6 weeks, 3 months, 6 months, 1 year, and 2 years). Statistical analysis was carried out using the paired t-test; statistical significance was set at p < 0.05. Results: 39 patients completed preoperative and postoperative questionnaires at a minimum of 6 months, with an average time to final questionnaire of 9.5 (range: 6-19) months. No patients went onto amputation, although 12 patients required secondary surgeries for adjustment of external fixator (n=8), infection (n=6), nonunion (n=5). FADI scores improved by 10.1 points from 42.7 to 52.8 (p=0.0004), corresponding to decrease in functional limitations. PROMIS-PI scores improved by 4.8 points from 63.7 to 58.9 (p=0.0009), corresponding to decrease in overall pain. PROMIS GH physical summary score increased by 2.7 points from 37.7 to 40.4 (p=0.03), although the mental summary score did not change significantly. PROMIS PF scores improved by 3.7 points, from 33.1 to 36.9 (p=0.002), indicating increased ability to perform activities of daily living. Conclusion: Patients in this cohort demonstrated clinically meaningful improvement in PROMs, including various domains of the PROMIS and the FADI, after undergoing reconstruction of diabetes-associated Charcot foot arthropathy.