Charcot Foot – Current Concepts

Abstract

Charcot neuropathic osteoarthropathy (CNO) is painless, progressive, noninfectious, degenerative arthropathy affecting single or multiple joints and soft tissues of foot and ankle caused by an underlying neurological deficit. The primary indication for surgical correction is a nonbraceble, nonplantigrade foot, instability, and impending or established ulceration. The goal of surgical management is to provide a stable, ulcer-free, plantigrade foot that can accommodate therapeutic footwear for self-ambulation. The choice of implants in midfoot CNO can be a combination of plate and screws well beyond the area of deformity to achieve rigid stability and good alignment following the principle of a super construct. The deformities involving the talus and ankle joint require a Total contact casting (TCC) arthrodesis, preferably with an intramedullary nail. The choices for soft tissue coverage as an additional procedure for ulcer management are guided by anatomic location, size, depth of ulcer, condition of surrounding soft tissue, and underlying deformity.

Fibular strut graft for primary ankle arthrodesis in diabetic charcot neuroarthropathy patients

“…Out of various non-surgical treatments, of which Total Contact Cast (TCC) is the gold standard treatment in acute Charcot neuroarthropathy [ 4 ]. Patients with exostosis, joint instability, pain with recurrent misalignment and scarring, fractures, osteomyelitis, and inability to ambulate should undergo surgery [ 5 ]. Arthrodesis surgery therapy is a procedure to save limbs to avoid amputation.…”