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Minimally Invasive Realignment Surgery for the Charcot Foot

  • Bradley M. Lamm
  • Dror Paley
Chapter

Abstract

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).

Keywords

External Fixation Deformity Correction Plantar Plating Taylor Spatial Frame Talar Neck 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

I thank Joy Marlowe, BSA, for her excellent illustrative artwork.

References

  1. 1.
    Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res 349:116–131, 1998CrossRefPubMedGoogle Scholar
  2. 2.
    Jolly GP, Zgonis T, Polyzois V. External fixation in the management of Charcot neuroarthropathy. Clin Podiatr Med Surg 20:741–756, 2003CrossRefPubMedGoogle Scholar
  3. 3.
    Wang JC, Le AW, Tsukuda RK. A new technique for Charcot’s foot reconstruction. J Am Podiatr Med Assoc 92:429–436, 2002PubMedGoogle Scholar
  4. 4.
    Frykberg RG, ed. The High Risk Foot in Diabetes Mellitus. New York, NY: Churchill Livingstone, 1991Google Scholar
  5. 5.
    Trepman E, Nihal A, Pinzur MS. Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int 26:46–63, 2005PubMedGoogle Scholar
  6. 6.
    Eichenholtz SN. Charcot Joints. Springfield, IL: C. C. Thomas, 1966Google Scholar
  7. 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
  8. 8.
    Brodsky JW, Rouse AM. Exostectomy for symptomatic bony prominences in diabetic Charcot feet. Clin Orthop Relat Res 296:21–26, 1993PubMedGoogle Scholar
  9. 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
  10. 10.
    Catanzariti AR, Mendicino R, Haverstock B. Ostectomy for diabetic neuroarthropathy involving the midfoot. J Foot Ankle Surg 39:291–300, 2000CrossRefPubMedGoogle Scholar
  11. 11.
    Paley D. Principles of Deformity Correction, Rev ed. Berlin: Springer; 2005Google Scholar
  12. 12.
    Lamm BM, Paley D. Deformity correction planning for hindfoot, ankle, and lower limb. Clin Podiatr Med Surg North Am 21:305–326, 2004CrossRefGoogle Scholar
  13. 13.
    Cooper PS. Application of external fixators for management of Charcot deformities of the foot and ankle. Foot Ankle Clin 7:207–254, 2002CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Rubin Institute for Advanced OrthopedicsSinai Hospital of BaltimoreBaltimoreUSA

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