Charcot Neuroarthropathy: Current Surgical Management and Update. A Systematic Review

Bajuri, Mohd Yazid; Ong, Shir Lee; Das, Srijit; Mohamed, Isa Naina

doi:10.3389/fsurg.2022.820826

Cited by 13 publications

(4 citation statements)

References 42 publications

(127 reference statements)

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“…Antibiotic-coated nails have been reported in a limited number of patients who failed the external fixator treatment [12]. A combination of talectomy and tibio-calcaneal arthrodesis was described for a Charcot foot deformity, but internal fixation was reserved for cases without foot ulcers and osteomyelitis [13,14]. Either external fixation or a hybrid fixation technique is favored in infected situations [15].…”

Section: Discussionmentioning

confidence: 99%

Salvage of Hindfoot Charcot with Osteomyelitis and Ulceration: A Case Report

2022

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Diabetic Charcot arthropathy of the ankle, due to the presence of multiplanar deformities, and associated medical comorbidities, poses a challenge for treating physicians. The situation becomes more complicated when accompanied by ulceration and osteomyelitis, leaving limited salvage options. We present a case of advanced Charcot ankle arthropathy with osteomyelitis and ulcerated hindfoot. It was managed by talectomy and antibiotic-impregnated cement beads, followed by hindfoot arthrodesis using a retrograde intramedullary nail six weeks later. This two-stage reconstruction approach resulted in an ulcer-free, stable, plantigrade foot at one-year postoperative follow-up.

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Section: Discussionmentioning

confidence: 99%

Salvage of Hindfoot Charcot with Osteomyelitis and Ulceration: A Case Report

2022

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“…In the domain of Charcot reconstruction pertaining to the hindfoot, arthrodesis stands as the cornerstone technique and most commonly involves tibiotalocalcaneal or tibiocalcaneal fusion[ 118 ]. Intramedullary nail (IMN), internal fixation or external fixation can be employed in isolation or combination.…”

Section: Charcot Managementmentioning

confidence: 99%

Surgical management of the diabetic foot: The current evidence

Roberts,

Davies-Jones,

Brock

et al. 2024

World J Orthop

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The prevalence of diabetes mellitus and its associated complications, particularly diabetic foot pathologies, poses significant healthcare challenges and economic burdens globally. This review synthesises current evidence on the surgical management of the diabetic foot, focusing on the interplay between neuropathy, ischemia, and infection that commonly culminates in ulcers, infections, and, in severe cases, amputations. The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies, as diabetic foot complications are a leading cause of hospital admissions among diabetic patients, significantly impacting morbidity and mortality rates. This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers, infections, and skeletal pathologies such as Charcot arthropathy, emphasising the critical role of early diagnosis, comprehensive management strategies, and interdisciplinary care in mitigating adverse outcomes. In addressing surgical interventions, this review evaluates conservative surgeries, amputations, and reconstructive procedures, highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies. The integration of advanced diagnostic tools, novel surgical techniques, and postoperative care, including offloading and infection control, are discussed in the context of optimising healing and preserving limb function.

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“…Following optimal deformity correction, the ankle, subtalar and midfoot bones are stabilised using either an external fixation or internal fixation or by combined methods ( 12 ). Even though, the external fixation was considered as the optimal method previously ( 13 ), internal fixation has become an increasingly common technique with bespoke fixation devices now available.…”

Section: Surgical Techniquementioning

confidence: 99%

Combined Charcot hindfoot and midfoot reconstruction using internal fixation method—surgical technique and single surgeon series

Kavarthapu¹,

Guduri²,

Hester³

2023

Ann Joint

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Isolated midfoot and hindfoot Charcot reconstruction using internal fixation is increasingly a common procedure in multidisciplinary diabetic foot units, and the surgical techniques using internal fixation have well been described. However, about a third of Charcot deformities that require surgical limb salvage present with the involvement of midfoot and hindfoot. Surgical reconstruction of a combined hindfoot and midfoot deformity is an evolving technique and technically challenging. We present the surgical technique of deformity correction and stabilisation using internal fixation, developed by the senior author (VK), and present the outcomes. All patients that had undergone combined hindfoot and midfoot reconstruction to address a limb threatening deformity due to Charcot neuroarthropathy, performed by the senior author, with a minimum follow-up of 12 months, have been included in this study. The principles of surgical reconstruction included adequate pre-operative optimisation of the patient, sequential deformity correction and stabilisation of the hindfoot followed by midfoot using the principle of long-segment rigid internal fixation with optimal bone opposition. Standard post-operative regime, including offloading, has been used in all patients. A total of 34 patients (35 feet) had undergone combined midfoot and hindfoot Charcot reconstruction between January 2009 and December 2019. Active ulcers were noted in 13 feet at the time of the procedure. Eleven reconstructions were performed as two-stage procedures due to the presence of active infection. At a mean follow-up of 53 months, 11/13 ulcer healed, and 32 patients (33 feet) were full weightbearing in surgical shoes or a brace at the latest follow-up. Bone fusion was noted in 28 feet in the hindfoot region and 32 feet in the midfoot. Metal work failure was noted in 5 feet requiring removal in 3 feet. Revision procedures were required in 4 patients. Our newly described technique of combined hindfoot and midfoot Charcot has provided functional limb salvage in majority of presentations, with an acceptable level of complications, at a medium-term follow-up of 53 months.

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Charcot Neuroarthropathy: Current Surgical Management and Update. A Systematic Review

Cited by 13 publications

References 42 publications

Salvage of Hindfoot Charcot with Osteomyelitis and Ulceration: A Case Report

Salvage of Hindfoot Charcot with Osteomyelitis and Ulceration: A Case Report

Surgical management of the diabetic foot: The current evidence

Combined Charcot hindfoot and midfoot reconstruction using internal fixation method—surgical technique and single surgeon series

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