Charcot Arthropathy of Foot and Ankle: Radiographic and Clinical Patterns with Related Outcomes

Abstract

Purpose Our aim is to retrospectively review and evaluate the patterns of affection of Charcot arthropathy of foot and ankle. Methods Two hundred twenty-eight patients (235 feet) with post-acute Charcot were reviewed and classified anatomically through plain radiographs into type I and type II based on single or multiple regions affected, respectively. Type I included ankle, Lisfranc (tarsometatarsal), naviculocuneiform, forefoot, and hindfoot which includes one of the following: talonavicular joint, calcaneocuboid joint, or calcaneus. Type II included peritalar, perinavicular, mid-tarsal Charcot, or any other combination. Both types were further classified into four stages (A, stable with no deformity; B, stable with deformity; C, unstable; and D, deformity/instability with associated mechanical ulcers). ResultsThe most common type was type IIC (27.2%) followed by type IID (18.3%), while types IA and IIA represented the least common types (3.4% and 3.8%, respectively). Types IA and IIA were managed conservatively. All patients in types IC, ID, IIB, IIC, and IID and the majority of type IB received fusion surgery to achieve stability and correction of deformity. Type II D had the highest complication rate (30%). Five patients ended up with amputation, and all were stage IID. Conclusion Affection of single region has better prognosis than affection of two or more regions. Stage A has the best prognosis and can be managed conservatively provided good diabetes control. Surgery is indicated in all cases of types IC, ID, IIB, IIC, and IID to achieve stability and correction of deformity and prevent complications. Mechanical ulcer (stage D) carries the worst prognosis and highest complication rate.

Interobserver and Intraobserver Reliability of a new prognostic classification for foot and ankle Charcot arthropathy

“…However, it was dependent solely on radiographs, and the ankle was not included in this classi cation which constituted up to 33% of cases of foot and ankle Charcot in previous study. [10] It should be noted that Sella and Barrette were the rst to combine both the anatomical and clinical description, however they were limited to medial column only. [2] Mansoura classi cation for foot and ankle Charcot arthropathy is applied mainly to post-acute Charcot.…”

“…1 and 2). [10] Thereafter, these twenty cases of foot and ankle Charcot, which were affecting different regions, were presented to participants with both clinical information and radiographs and they were asked to rate each case according to the classi cation. The level of experience of all the participants was collected and classi ed as less than 5 years, 5-10 years, 10-15 years, 15-20 years and more than 20 years.…”

“…Other classi cation systems are focused on the midfoot [2,7,9] and didn't consider the ankle joint which is included in the peritalar charcot and constitutes one third of cases of foot and ankle Charcot in previous reports. [10] The majority of the aforementioned classi cations are mainly descriptive, and they didn't guide the management or the outcome in relation to the classi cation stage.…”

“…A recent classi cation (Mansoura Classi cation) was published which considered the anatomic regions as well as the presence of instability, deformity and ulcers. [10] This new classi cation attempted to guide the treatment and prognosis of foot and ankle Charcot arthropathy.…”

Ankle and foot surgery: from arthrodesis to arthroplasty, three dimensional printing, sensors, artificial intelligence, machine learning technology, digital twins, and cell therapy

“…For a very long time, the most frequent indication was the treatment of poliomyelitis. With the development of new techniques and the success of arthrodesis, the indications have extended to post-traumatic osteoarthritis other neurological diseases such as Charcot arthropathy [6], the correction of adultacquired flatfoot deformity [7][8][9], osteonecrosis of the talus, and sequelae of cerebral palsy. The frequency of post-traumatic ankle arthrodesis has increased in recent years due to sports practice; however, sports activity level [10] following an ankle fusion is decreased, and many patients will not return to their pre-injury level of activity.…”