Foot & Ankle International - July 2018 - 808

762138
research-article2018

FAIXXX10.1177/1071100718762138Foot & Ankle InternationalKroin et al

Article

Improvement in Quality of Life
Following Operative Correction of
Midtarsal Charcot Foot Deformity

Foot & Ankle International®
2018, Vol. 39(7) 808-811
© The Author(s) 2018
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https://doi.org/10.1177/1071100718762138
DOI: 10.1177/1071100718762138
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Ellen Kroin, MD1, Edwin O. Chaharbakhshi, BS2, Adam Schiff, MD1,
and Michael S. Pinzur, MD1

Abstract
Background: Patients with Charcot foot arthropathy report a poor quality of life following the development of deformity.
Their quality of life is often not improved with "successful" historic accommodative treatment. There is increased current
interest in operative correction of the acquired deformity with the stated goals of achieving both the traditional goals of
resolution of infection and limb salvage as well as the desire to improve quality of life. The Short Musculoskeletal Functional
Assessment (SMFA) outcomes instrument appears to be a valid tool for evaluating this complex patient population.
Methods: Twenty-five consecutive patients undergoing operative reconstruction for nonplantigrade midtarsal Charcot
foot arthropathy completed the SMFA patient-reported outcomes instrument prior to surgery, with 24 completing it at 1
year following the surgery. One patient died during the year following surgery from unrelated causes.
Results: There was an 11.5-point (95% confidence interval [CI]: -19.7 to −3.2) decrease in the standardized functional
index (P = .01). Similarly, there was a 12.4-point (95% CI: -22.5 to −2.3) decrease in the standardized bother index (P =
.02). The standardized daily activity index demonstrated a 19.6-point decrease (95% CI: -30.5 to −8.6, P = .002), and there
was a 14.7-point (95% CI: -24.1 to −5.3) decrease in the standardized emotion index (P = .004). There was no meaningful
change in the standardized arm/hand index (P = .81).
Conclusion: The results of this investigation demonstrate that successful operative reconstruction of midtarsal Charcot
foot arthropathy improved quality of life. This supports the modern paradigm shift from immobilization during the active
phase of the disease process followed by simple accommodation of the acquired deformity to the modern interest in
operative correction to allow the use of commercially available therapeutic footwear.
Level of Evidence: Level IV, case series.
Keywords: Charcot foot, diabetic foot, deformity

Introduction
Several investigations have demonstrated that the historic
treatment of Charcot foot arthropathy, encompassing immobilization during the active phase of the disease process followed by accommodative bracing, is not successful in
reversing the negative effects on quality of life in affected
individuals.3,5,8,11 This appreciation has been the impetus for
the current interest in operative correction of the acquired
deformity.10,12,13,14,15
The metrics that have been most commonly used to report
clinical outcomes following historic accommodative treatment have simply encompassed eradication of infection and
limb salvage. The metrics associated with surgery have also

been the traditional metrics of resolution of infection, wound
healing, or successful arthrodesis. Most authors have not
addressed functional goals or patient perception of outcome.
Subjecting this highly comorbid patient population to the
risks associated with anesthesia and surgery requires a
1

Department of Orthopaedic Surgery & Rehabilitation, Loyola University
Health System, Maywood, IL, USA
2
Loyola University Medical School, Maywood, IL, USA
Corresponding Author:
Michael S. Pinzur, MD, Department of Orthopaedic Surgery &
Rehabilitation, Loyola University Medical Center, 2160 South First
Avenue, Maywood, IL 60153, USA.
Email: mpinzu1@lumc.edu

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