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Neuropathic osteoarthropathy, i.e., Charcot's joint, has not previously been reported as a sequela of elective foot surgery. The authors present a challenging case of a patient with long-standing diabetes mellitus and peripheral neuropathy who developed neuropathic osteoarthropathy after a Keller arthroplasty for a recalcitrant hallux ulcer. The radiographic findings, diagnostic tests, and histopathology are discussed. Finally, the authors offer suggestions for surgeons contemplating a Keller arthroplasty for patients with peripheral neuropathy.

The authors performed a retrospective study of the safety and efficacy of toenail phenol and alcohol chemical matrixectomy in diabetic versus nondiabetic patients. Participating in the study were 66 patients, who underwent 137 nail procedures. The diabetic group consisted of 18 patients who underwent 39 procedures; the nondiabetic group consisted of 48 patients who underwent 98 procedures. The mean (+/- SD) healing time was 44 +/- 25 days for the diabetic group and 43 +/- 24 days for the nondiabetic group. The infection rate was 10.3% (4 of 39 procedures) for the diabetic group and 12.2% (12 of 98 procedures) for the nondiabetic group. In addition to validating this procedure for diabetic patients, this study showed no significant differences in the rate of postoperative complications between the two groups.