Beaming the Columns for Charcot Diabetic Foot Reconstruction: A Retrospective Analysis

This study explored the concept of "beaming" the medial and lateral longitudinal columns as a variation of the current technique for hindfoot and Lisfranc Charcot reconstruction. We reviewed radiographic changes and outcomes for patients who underwent Charcot foot reconstruction at our facility over the 14-year period from January 1994 to January 2008. Beaming was performed on 71 Charcot foot deformities in 70 patients, 22 (31%) of which displayed an isolated hindfoot deformity, 20 (28%) an isolated Lisfranc deformity, and 29 (41%) with a combination of hindfoot and Lisfranc deformities. The average radiographic follow up was 31.00 +/- 22.97 months. Group 1 consisted of reconstructions that involved only medial and lateral column beams and showed significant improvements in radiographic alignment between the preoperative and postoperative measurements, including Meary's angle (P < .001), calcaneal inclination angle (P - .004), tarsometatarsal angle (P = .002), talonavicular angle (P = .035), and the calcaneocuboid angle (P = .006). Group 2, which consisted of reconstructions that involved medial and lateral column beams and either a subtalar arthroereisis (n = 18) or a subtalar joint fusion (n = 10), also showed significant improvements, including Meary's angle (P < .001), tarsometatarsal angle (P < .001), talonavicular angle (P = .002), and the calcaneocuboid angle (P < .001), although calcaneal inclination did not statistically significantly change (P = .054). In both groups, the surgical intervention maintained the correction and was useful for Charcot reconstruction. Complications included pin tract infections, broken pin, osteomyelitis, transfer lesions, and ulcerations. (C) 2011 by the American College of Foot and Ankle Surgeons. All rights reserved.