What is the role of surgery in the treatment of Charcot arthropathy?

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

Surgical procedures and techniques used to treat Charcot arthropathy vary, depending on the location of the disease and on the surgeon's preferences and experience with this condition. Surgical procedures that may be considered include the following:

  • Exostosectomy of bony prominence
  • Osteotomy
  • Arthrodesis
  • Screw and plate fixation
  • Open reduction and internal fixation (ORIF)
  • Reconstructive surgery
  • Fusion with Achilles tendon lengthening
  • Autologous bone grafting
  • Amputation

Patients treated with surgery have longer healing times. [11]

Surgical methods can be based on Schön's classification system. The following recommendations may be made:

  • Augmented ORIF should be used for an ankle with displaced fractures
  • Ankle arthrodesis is necessary in patients with tibiotalar destruction
  • In cases in which the hindfoot has avascular necrosis of the talus, a talectomy with tibiocalcaneal fusion is necessary
  • Arthrodesis may be necessary for patients with hindfoot involvement
  • For a midfoot pattern, surgical correction of rocker-bottom deformity and osteotomies for bony prominences are used
  • If there is an associated hindfoot/ankle equinus contracture, then a posterior release/Achilles tendon lengthening procedure is required
  • For forefoot patterns, patients with bony prominences or recurrent ulcerations may need a resection arthroplasty or cheilectomy

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