Charcot hindfoot deformity reconstruction using a hindfoot nail- surgical technique

Abstract

Various techniques of reconstruction of deformed Charcot hindfoot using different internal fixation devices have been described in the literature. We present our surgical technique using specific principles that has resulted in improved outcomes to allow correction of deformity, obtain stability and allow progression to weightbearing in orthotic shoes. We describe our preoperative evaluation, planning and surgical timing. We also hope to share some technical pearls and details on the finer points to achieve a satisfactory correction and reduce the learning curve.

Predictors of metalwork failure and nonunion after hindfoot Charcot reconstruction

“…An intact medial malleolus allows optimal positioning of the talus in the medial gutter corner, providing additional stability, particularly of the axial plane, and increases the surface area of bone contact. 10 We also demonstrated that talectomy did not affect the hindfoot union rates, although it did increase the risk of midfoot deformity recurrence. We feel that this is due to instability in the Charcot affected midfoot, as the navicular articulates with distal tibia anteriorly.…”

“…Additional screws and/or plates are often needed to improve the rigidity of the fixation construct. 10 We have found a union rate of 83%. Our union rates after hindfoot Charcot reconstruction are similar to those in the literature, 8,16 with overall fusion rates quoted at around 86%.…”

“…23,24 Once the IMN is inserted, supplementary compression should be undertaken in a controlled fashion to compress the tibiotalar and subtalar joints and achieve optimal bone opposition. 10,22 We have demonstrated that supplementary compression screws provide additional compression and rotational stability at the fusion site, which in turn may contribute to bony union.…”

“…Even though the underlying comorbidities could contribute partly to these suboptimal outcomes in this cohort of patients, inadequate fixation achieved during Charcot hindfoot reconstruction is considered as an important contributor. 10 The primary aim of this study was to identify the factors related to the suboptimal hindfoot-specific outcomes, including metalwork failure, recurrent deformity, and nonunion, in patients undergoing hindfoot Charcot reconstruction with a standard hindfoot IMN. Generic outcome measures included weightbearing status, type of footwear, ulcer recurrence, and mortality.…”

“…Even though the underlying comorbidities could contribute partly to these suboptimal outcomes in this cohort of patients, inadequate fixation achieved during Charcot hindfoot reconstruction is considered as an important contributor. 10…”