Time critical charcot foot reconstructions can be safely performed in the absence of optimal preoperative glycaemic control when delivered by MDT.

Abstract

Aim: Established guidelines recommend a pre-operative HbA1c target of 8.5 % for elective surgeries. Patients waiting for Charcot foot reconstructions often have impaired mobility and fail to achieve this target, and risk getting their surgeries delayed or cancelled. In our unit, the multidisciplinary team (MDT) recommends proceeding with surgery even if the target HbA1c levels are not achieved. Our aim is to review the patient outcomes among patients with diabetes and variable pre-operative glycaemic control undergoing Charcot foot reconstructions.

Materials and methods: We reviewed the clinical outcomes and glycaemic control of consecutive patients that had undergone elective Charcot foot reconstructions over a 22-month period with a minimum follow-up of 12 months.

Results / discussion: 18 diabetic patients were operated on between October 2020 and August 2022, including 8 midfoot, 2 hindfoot and 8 combined hindfoot and midfoot reconstructions. There were 11 males, the mean age was 56.7 years, the mean preoperative HbA1c was 7.9 %. In 7 patients, the preoperative recommended HbA1c target of 8.5 % was not achieved (non-target group). There were 4 post-operative complications, all resolved with conservative management. There were no renal or cardiac complications. After one year, 61 % (n = 11) of patients were mobilising in shoes. There was no outcome difference between the groups with or without the targeted glycaemic control.

Conclusion: Although preoperative glycaemic optimization should be aimed for, the time critical Charcot foot reconstructions can still be performed in the absence of targeted glycaemic control if delivered by MDT.