How is Charcot arthropathy treated?

Updated: Jun 21, 2018
  • Author: Mrugeshkumar Shah, MD, MPH, MS; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Treatment of Charcot arthropathy has been primarily nonoperative. Treatment is carried out in two phases: an acute phase and a postacute phase. Management of the acute phase includes immobilization and reduction of stress (see Medical Therapy below). [11]

Surgery is warranted in fewer than 25% of cases and generally is used as a preventive measure. Surgery is performed when a deformity places the extremity at risk of ulceration and when the extremity cannot be safely protected in accommodative footwear. The goal of reconstruction is to create a stable, plantigrade foot that can be appropriately protected in accommodative footwear and that can support ambulation. [12]  Surgery is indicated for malaligned, unstable, or nonreducible fractures or dislocations, as well as for cases in which nonsurgical means fail.

The major contraindication for surgery is active inflammation. Studies have shown less favorable outcomes when surgery is performed on an acute joint.

Several authors, including Simon et al, [13] have suggested that early surgical treatment in the acute phase may be a feasible alternative to nonoperative management. However, the optimal timing of surgery remains to be determined. [14]


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