Single Stage Correction with External Fixation of the Ulcerated Foot in Individuals with Charcot Neuroarthropathy

Abstract

The ulcerated foot in individuals with Charcot neuroarthropathy presents a complex problem when correction of the deformity is necessary but the presence of infection precludes the use of internal fixation. We reviewed 11 patients with midfoot Charcot neuroarthropathy, collapse, and ulceration who were at risk for amputation. These patients underwent operative debridement, corrective osteotomy, external skeletal fixation and culture-directed antibiotic therapy as a limb salvage procedure. Patients were transitioned from the external fixator (average 57 days) to total contact casting (average 131 days) and all subsequently progressed to therapeutic footwear in 12 to 49 months of follow-up (average 24 months), except one patient whose medical decline resulted in bedrest. We believe that when performed in properly selected patients, this procedure presents an alternative to amputation and, via corrective osteotomy, results in a shoe-able, functional foot that is potentially less prone to ulceration.

The role of circular fixation in the treatment of Charcot foot

“…Although complications will be discussed in a separate section, the reader should be cautioned that, in the author's experience, complication rates (especially pin track irritation and infection) occur at a higher rate than those reported above and should be handled accordingly. 9 In 2002, Farber et al 10 reported 11 patients with midfoot Charcot arthropathy and ulceration. A single-stage procedure was performed consisting of debridement, corrective osteotomy and application of a Hoffman-type external fixator.…”

Can we predict outcome of surgical reconstruction of Charcot neuroarthropathy by dynamic plantar pressure assessment?—A proof of concept study

“…In these cases, Charcot reconstruction is necessary for limb salvage. Charcot reconstruction has been shown to be an effective method of correcting the deformity and providing a stable, plantigrade, foot [30][31][32][33].…”

Corrective surgery in diabetic foot deformity

“…External fixation as an alternative to internal fixation allows rapid mobilization and is the subject of several papers [11,12]. Although some claim no pin tract infections, this seems unlikely since even non-diabetic patients regularly have infections if the system is used over an extended period of time.…”

“…plates, screws [10] and intramedullary nails [11,12] are used). The resection of metatarsal heads or bony prominences has also been described [13] and partial or total calcaneal resection is reported [14].…”