Management of Osteomyelitis and Bone Loss in the Diabetic Charcot Foot and Ankle

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Key points

  • Bone loss secondary to osteomyelitis in diabetic Charcot neuroarthropathy (CN) can be challenging to manage and especially in the presence of multiple medical comorbidities and poorly controlled diabetes mellitus.

  • A staged approach to reconstruction is recommended with an initial surgical debridement of the infected osseous and soft tissue structures in the patient with diabetic CN with concomitant osteomyelitis.

  • Surgical procedure selection, fixation methods, and bone-grafting techniques are

Preoperative considerations

Management of bone loss in the patient with diabetic CN should begin with a thorough history and physical examination by determining the anatomic location and size of the defect, joint contracture and range of motion, presence and degree of deformity, concomitant soft tissue injury, vascular supply, and the presence of infection (Fig. 1). Additionally, retained hardware and/or surgical complications from previous surgeries as well as the overall health status and management of medical

Single versus staged reconstruction

Currently, there are no studies comparing immediate versus delayed bone grafting in the diabetic CN with bone loss and osteomyelitis. In the absence of concomitant infection, a single-stage reconstruction might be able to achieve the desired outcome. The type of bone grafting, along with the procedure and fixation selection is dependent on the anatomic location, previous surgeries, amount of bone loss, and overall health status of the patient. In the presence of concomitant infection, a staged

Bone-grafting options

Autogenous bone grafting remains the mainstay standard in bone graft selection due to its osteoconductive and osteoinductive growth factors and osteogenic cells.8 The autogenous bone can be harvested from anatomic structures, such as the iliac crest, proximal tibia, medial malleolus, and fibula, among many others. The corticocancellous structure allows for cell migration, proliferation, and anatomic stability. Some of the disadvantages of harvesting autogenous bone graft, especially in the

Summary

The surgical management of diabetic CN with concomitant osteomyelitis and bone loss is a challenging surgical entity and successful outcomes are dependent on multiple factors, including the patient’s management of medical comorbidities and severity of concomitant infection. The procedure selection, fixation methods, and bone-grafting techniques also are determined on an individualized clinical case scenario and best managed by a multidisciplinary team approach with an interest in the medical

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