Surgical Reconstruction of Charcot Foot

Charcot foot (neuropathic osteoarthropathy) is a progressive disease of the foot that causes joint dislocations, pathological fractures and non-infectious destruction of bones and joints. The joints between the tarsal and metatarsal bones are most commonly affected.

Diabetic neuropathic osteoarthropathy (DNOAP) - a complication of diabetes mellitus - is the most common form. It is a rather rare disease. Given the increasing number of diabetes patients worldwide, the prevalence is expected to increase significantly.

Charcot foot causes extensive bone loss and associated instability as well as foot misalignment. The treatment is very complex and represents a major challenge for the orthopedic surgeon. The aim is to prevent open ulcers and correct misalignments so that wearing shoes is possible again.

The treatment approach depends on the course and stage. In principle, there are four stages. In stage I, conservative treatment should initially be carried out. The foot is completely relieved and immobilized with the help of special plaster (total contact cast) or orthoses.

A careful diagnosis by foot specialists with a detailed medical history, clinical examination, X-ray and, if necessary, MRI is important, as Charcot foot is often not recognized. The clinical examination usually shows a red, swollen, overheated foot that may falsely suggest a bacterial infection. Erysipelas, thrombosis and osteomyelitis (bacterial inflammation of the bone) are still among the most common misdiagnoses.

In our opinion, surgical treatment is indicated in stages 3 and 4, as well as in those cases in which conservatively treated ulcerations do not heal or shoes cannot be worn due to severe foot misalignments.

Surgical therapy includes a number of different techniques that are used depending on the case:

• Lengthening the Achilles tendon reduces pressure on the heel, thereby preventing further ulceration in the area.
• In the case of isolated, protruding bones, removal of the bone growth may also be indicated (exostosis removal).
• With new surgical methods, instabilities can be corrected and collapsed arches can be reconstructed.
• The aim of the operation is always to reduce pressure, enable shoe fitting and avoid amputations.
• Even in an advanced stage, these reconstructive measures lead to good functional results, meaning that amputations can be prevented to a large extent.

Especially in view of the sensitivity disorders typical of diabetes, it is extremely important that patients comply with the prescribed relief. Most complications (infections, osteomyelitis, screw loosening or breakage, recurrences, wound healing disorders) can be significantly reduced or avoided.

Contact:

Confraternität Private Hospital

Skodagasse 32
1080 Vienna • Austria

T: +43 1 401 14-5873
E: international@pkj.at