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pre- and post-transplantation. When a problem of the foot
and ankle occurred, the patient visited the hospital immediately and additional investigations (eg, simple radiograph,
magnetic resonance imaging, bone scan, angiography,
ankle-brachial index, neurometer, vibration sensory exam,
and electromyography and nerve conduction study) were
performed.
Foot and ankle complications included Charcot arthropathy, insufficiency fracture, toe or lower-limb amputation
because of vascular or infectious complications, and chronic
foot ulcer. Chronic foot ulcer was defined as a long-lasting
foot lesion with ulceration associated with neuropathy and/
or peripheral arterial disease of the lower limb. Insufficiency
fracture was defined as uncertain trauma-related fracture
without Charcot arthropathy. Injury-related foot complications such as traumatic fracture, or sprain and non-diabetesrelated foot complications such as cellulitis, corns, callosity,
ingrown nails, etc, were excluded.
All medical records and examinations were retrospectively reviewed. Gender, duration of diabetes before transplantation, age at transplantation, length of follow-up period
after transplantation, diabetes type, transplantation type,
HbA1c levels (before surgery as well as 6 months and 1 year
after surgery), creatinine level, fasting glucose levels, and
cumulative immunosuppression regimens (methylprednisolone, deflazacort [Calcort], fludrocortisone [Florinef], etc)
were evaluated and described. The anatomic location of the
foot problem was defined and described.
A comparison was made between patients who developed diabetic foot complications after pancreas transplantation (the Complication Group) and those who did not (the
Noncomplication Group). Predisposing factors for developing diabetic foot complications after pancreas transplantation were analyzed.

Statistical Analysis
Descriptive statistics were used to provide demographic
data and foot complication findings.
The duration of diabetes before transplantation, age at
transplantation, length of follow-up period after transplantation, HbA1c levels before transplantation and at 6
months and 1 year after transplantation, creatinine and
fasting glucose levels, and the patients' cumulative immunosuppression regimens were compared between the 2
groups using Student t test. Categorical parameters such
as gender, diabetes type, and transplantation type were
analyzed using Pearson chi-square test when all the cells
had a frequency of more than 5, or using Fisher exact test
when any block had a frequency of 5 or less. A P value
<.05 was considered as statistically significant. Statistical
analyses were analyzed using SPSS version 21.0 (SPSS
Inc, Chicago, IL).

Foot & Ankle International 38(6)

Results
Diabetic Foot Complications
Of the 218 patients, 22 patients (10.1%) had foot and ankle
complications after successful pancreas transplantation.
Fifteen patients (6.9%) had a diabetic foot ulcer and 7 patients
(3.2%) had Charcot arthropathy. Three patients (1.4%) with
insufficiency fractures were identified. The mean time to
develop foot complications after transplantation was 18.5
(range, 2-77) months. Diabetic foot complications occurred
in 15 of 22 patients within 1 year of transplantation (Table 2).

Diabetic Foot Ulcer
Fifteen patients (6.9%) had diabetic foot ulcer. Three
patients of the 15 had both Charcot arthropathy and diabetic
ulcer. The mean age of patients with diabetic foot ulcer was
43.1 years. There were 14 patients with type 1 DM. The
mean diabetes duration before pancreas transplantation was
17.1 years, and the mean follow-up period was 4.6 years.
The mean time to development of diabetic foot ulcer after
pancreas transplantation was 14.1 (range, 2-56) months.
Diabetic ulcers were found in the toe and the sole of the
metatarsophalangeal joint in 11 and 3 patients, respectively.
Two patients had heel ulcerations and 2 patients had lateral
malleolar ulcerations (Table 2).

Charcot Arthropathy
There were 7 patients (3.2%) with Charcot arthropathy.
Four and 3 patients had ankle and subtalar joint and Lisfranc
joint involvement, respectively (Figure 1). The mean age of
patients was 41.7 years. There were 5 patients with type 1
DM. The mean diabetes duration before pancreas transplantation was 13.6 years, and the mean follow-up period after
pancreas transplantation was 3.8 years. The mean time to
diagnosis of complications after pancreas transplantation
was 21.7 (range, 5-64) months.

Insufficiency Fracture
Three patients (1.4%) had insufficiency fracture. Two
patients had insufficiency fractures in a fourth and fifth
metatarsal shaft. Insufficiency fracture of one other patient
occurred in the distal tibia.

Comparison Between the Complication Group
and Noncomplication Group
In both groups, laboratory examinations (HbA1c, fasting
glucose, and creatinine levels) were normalized at 6 months
and 1 year after transplantation. Creatinine level at 1 year

Table of Contents for the Digital Edition of Foot & Ankle International - June 2017