Minimally Invasive Realignment Surgery for the Charcot Foot
The aftermath of Charcot, joint subluxation and loss of the bone quality, produces abnormal osseous prominences, which are potential areas for ulceration. Due to the deformed pedal position, the muscle-tendon balance is altered and the resultant aberrant weight-bearing forces increase the risk for ulceration. If ulcers are present, osteomyelitis can ensue, thus, if ulcers are present, they should be eradicated. The best treatment results are achieved when treatment is initiated during the early stages of Charcot neuroarthropathy.
The goal of treatment in the acute Charcot neuroarthropathy is to stabilize the condition. The traditional treatment is total contact casting for immobilizing. However, non-weight bearing in a total contact cast produces osteopenia of the ipsilateral foot and increased weight-bearing forces on the contralateral foot. These resulting sequelae can make it difficult for sequent surgery and can lead to ulceration and Charcot neuroarthropathy in the contralateral foot. Maintaining non-weight-bearing status is difficult for this patient population for multiple reasons (e.g., muscle atrophy, obesity, diminished proprioception).
KeywordsExternal Fixation Deformity Correction Plantar Plating Taylor Spatial Frame Talar Neck
I thank Joy Marlowe, BSA, for her excellent illustrative artwork.
- 4.Frykberg RG, ed. The High Risk Foot in Diabetes Mellitus. New York, NY: Churchill Livingstone, 1991Google Scholar
- 6.Eichenholtz SN. Charcot Joints. Springfield, IL: C. C. Thomas, 1966Google Scholar
- 7.Shibata T, Tada K, Hashizume C. The results of arthrodesis of the ankle for leprotic neuroarthropathy. J Bone Joint Surg 72A:749–756, 1990Google Scholar
- 9.Simon SR, Tejwani SG, Wilson DL, Santner TJ, Denniston NL. Arthrodesis as an early alternative to nonoperative management of Charcot arthropathy of the diabetic foot. J Bone Joint Surg 82A:939–950, 2000Google Scholar
- 11.Paley D. Principles of Deformity Correction, Rev ed. Berlin: Springer; 2005Google Scholar