Can Scaling Theory Aid In Charcot Foot Reconstruction In Obese Patients?
- Volume 26 - Issue 3 - March 2013
- 3365 reads
- 0 comments
Despite a national awareness of obesity and widespread efforts to educate the public, our nation is still gaining weight at an alarming rate. It may be time to view this weight gain as inevitable and evolutionary, and subsequently attempt to mimic and incorporate scaling theory findings that have occurred in other graviportal species into our practices.
Charcot neuroarthropathy represents a situation in which so-called “normal” human anatomy has failed. The musculoskeletal tissue and support structures in a patient with a normal BMI may not be sufficient to support our patients with larger BMIs. Although we do not consider these findings to be definitive or conclusive, we hope it does present at least a different paradigm looking forward into treatment algorithms for this challenging group of podiatric patients.
Dr. Meyr is an Assistant Professor in the Department of Podiatric Surgery at the Temple University School of Podiatric Medicine in Philadelphia.
Dr. Pirozzi is a fourth-year resident with the Temple University Hospital Podiatric Surgical Residency Program.
Dr. Creech is a second-year resident with the Temple University Hospital Podiatric Surgical Residency Program.
1. Vela SA, Lavery LA, Armstrong DG, Anaim AA. The effect of increased weight on peak pressures: implications for obesity and diabetic foot pathology. J Foot Ankle Surg. 1998; 37(5):416-20.
2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009–2010. NCHS data brief, no 82. National Center for Health Statistics, Hyattsville, MD, 2012.
3. Sohn MW, Budiman-Mak E, Lee TA, Oh E, Stuck RM. Significant J-shaped association between body mass index (BMI) and diabetic foot ulcers. Diabetes Metab Res Rev. 201; 27(4):402-9.
4. Stuck RM, Sohn MW, Budiman-Mak E, Lee TA, Weiss KB. Charcot arthropathy risk elevation in the obese diabetic population. Am J Med. 2008; 121(11):1008-14.
5. Miller CE, Basu C, Fritsch G, Hildebrandt T, Hutchinson JR. Ontogenetic scaling of foot musculoskeletal anatomy in elephants. J R Soc Interface. 2008; 5(21):465-75.
6. Weissengruber GE, Egger GF, Hutchinson JR, Groenewald HB, Elsasser L, Famini D, Forstenpointner G. The structure of the cushions in the feet of African elephants (Loxodonta africana). J Anat. 2006; 209(6):781-92.
7. Fisher RE, Scott KM, Adrian B. Hind limb myology of the common hippopotamus, Hippopatamus amphibius (Artiodactyla: Hippopotamidae). Zoological Journal of the Linnean Society. 2010; 158: 661-682.
8. Grant WP, Garcia-Laven S, Sabo R. Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis. J Foot Ankle Surg. 2011; 50(2):182-9.
9. Assal M, Stern R. Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. J Bone Joint Surg Am. 2009; 91(4):812-20.
10. Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB. Off-loading the diabetic foot wound: a randominzed clinical trial. Diabetes Care. 2001; 24(6):1019-22.
For further reading, see “Limb Salvage And The Charcot Foot: What The Evidence Shows” in the March 2011 issue of Podiatry Today.