Quality of Life Improvement Following Reconstruction of Midtarsal Charcot Foot Deformity: A Five Year Follow-Up

CATEGORY: Diabetes INTRODUCTION/PURPOSE: Previous data has suggested that patients have significant clinical improvement after reconstruction of diabetes-associated Charcot foot arthropathy at one year postoperatively. The purpose of this study is to re-evaluate a cohort of patients who were previously surveyed pre-operatively and 1 year post-operatively following Charcot foot reconstruction to determine if improvements in quality of life measures were sustained at a 5-year interval post-operatively. METHODS: Twenty-four patients were contacted to repeat the Short Musculoskeletal Function Assessment (SMFA) 5 years after their index Charcot foot reconstruction. The same cohort of patients had completed the SMFA pre-operatively and at 1 year post-operatively. The response to items were summated to establish scores on the dysfunction and bother indices. The scores were then standardized to range from 0 to 100 with use of the published scoring formula. Poorer function is indicated by higher scores. Descriptive statistics were utilized to analyze the differences between the preoperative and five year data for the group. Sixteen of the initial 24 study patients (66.6%) were successfully contacted and completed the SMFA survey at five years postoperatively; 2 of the 16 had subsequently undergone amputation. RESULTS: Fourteen patients who had previously completed the SMFA preoperatively and 1 year postoperatively after Charcot foot reconstruction in a circular frame were contacted and again completed the SMFA instrument. Improvement was noted in all domains measured by the SMFA between preoperative scores and five years postoperative scores; there was a 17-point decrease in the SMFA standardized functional index and a 3.6-point decrease in bother index. Similarly, when looking at individual domains, there was a 8.7-point decrease in difficulty with daily activities, 4-point improvement in emotion, and 5.7-point improvement in mobility. There was a statistically significant improvement in difficulty with daily activities at five years (p = 0.037), All other domains assessed by the SMFA demonstrated improvement between the two time periods, but did not reach significance due to the limited sample size. CONCLUSION: Successful correction of non-plantigrade midtarsal Charcot foot arthropathy is associated with a clinically meaningful improvement in health-related quality of life at both one and five years postoperatively, including independence with daily activities. This further supports the modern paradigm shift towards operative correction of this deformity.