Friday, 27 March 2015

A to Z of Charcot Foot Reconstruction

People suffering from neuropathy (considerable nerve damage) have weakened bones in the foot, which are prone to stress buildup, and may eventually suffer a crack or fracture. This condition is called Charcot foot. With continued walking, the injured foot or ankle is subjected to continuous pressure. As the disorder reaches an advanced stage, it can finally lead to a collapse of the joints, which would give an abnormal shape to the foot.

Charcot foot is an extremely serious disease that can cause disability and deformity. Some cases may even lead to amputation. That’s why it becomes important for those with diabetes, a disease connected to neuropathy, to take preventive measures and consult a doctor as soon as they spot symptoms of Charcot foot. 


Common symptoms of Charcot foot could include:
  • Redness in the foot
  • Feeling of warmth in the affected foot
  • Soreness
  • Swelling in the area
  • Pain

Treating Charcot Foot

The optimal treatment for this condition, which could be either amputation or salvage, has been a subject of long-term debate among orthopedic surgeons. Though non-operative treatment options include limiting any walking, weight bearing and loading of the foot and ankle until the bone has healed, it may not give effective results in severe cases. During such instances, surgical intervention may become necessary. 

Depending on the extent of ulcerations, foot deformities and instability, the best surgical option is assessed. From simple exostectomy with ulcer excision, exostectomies with rotational flaps, free tissue transfers, to arthrodesis (major elective reconstruction) as well as internal and external fixation, there are various surgical treatment options available today. However, the key to successful reconstruction depends on proper selection of the procedure and patient compliance. Though patient compliance may seem like a foregone conclusion, it becomes important to educate patients about the need for a period of non-weight bearing post-operative phase where the foot heals slowly and eventually becomes free of pain.

For treating Charcot joints, the clear winner is arthrodesis. This procedure involves joint fusion between two bones via surgery that helps in realignment and correction of deformities, improves function, eliminates instability and helps in the maintenance of such corrective steps. 

Usually, the level of fusion (triple, mid-foot or ankle arthrodesis) is determined by the extent of the deformity. In these complex fusions, the use of screws, plates and intramedullary nails has become a standard practice these days as they offer improved outcomes with better solid fixation. In recent years, an increase in the usage of external fixation has been noticed. In reconstructive surgery of the Charcot foot and ankle, surgeons may use external, internal and combined fixation, after assessing what the situation demands.  

Past vs. Present

Earlier, standard methods of internal fixation were used for corrective surgery, which was performed as a staged procedure. The first stage involved resection of the infected bone while internal fixation was applied at the second operation. Today, fine-wire external fixation is used to conduct a single-stage resection along with correction. To maintain the correction, a fine-wire (multi-plane) external fixator is used.  

Charcot foot adversely affects the patient’s quality of life and creates a severe negative impact on his/her overall health. Therefore, it becomes important to consult an orthopedic or foot and angle surgeon on time to avoid amputation and get the limb salvaged.