Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

Abstract

Introduction and purpose:Charcot neuroarthropathy defines a cluster of progressive lesions affecting the joints and bones, as well as the soft tissues of the foot in the context of diabetes, a pivotal role being attributed to peripheral neuropathy. Loss of sensation and proprioception, subsequent repeated trauma, muscle and autonomic nervous system impairment contribute to the alteration of the foot’s architecture and distribution of pressure, ultimately triggering ulceration and gangrene. The urge to avoid amputation has fueled the development of conservative and reconstructive techniques capable of delaying, if not preventing such negative outcomes. The purpose of this review was to present the most frequently used reconstruction procedures and the challenges arising in adapting them to particular foot morphologies and lesion stages. Methods:Literature search was conducted using PubMed, resulting in around 90 articles, multicenter studies and reviews, 26 of which were considered most relevant in providing the guidelines for orthopedic reconstruction and postoperative care in Charcot foot patients with diabetic neuropathy prevailing over arteriopathy. Results:The tarsometatarsal and metatarsophalangeal joints are most frequently affected. Closed reduction, arthrodesis, and tendon lengthening are key features of an efficient correction, alternatively accompanied by resections and tenotomies. Ulceration and callus debridement may also be necessary, while prolonged casting and immobilization remain obligatory. Conclusions:Most authors agree that stabilizing the deformities, optimizing the pressure on the soft tissues, and promoting the healing of potential lesions are the main purposes of the interventions. Prompt recognition and correction of Charcot foot deformities improve life quality and minimize the prospects of amputation.