Innovative techniques and concepts in surgical management of Charcot foot deformities

Abstract

Abstract There is a growing interest in the surgical treatment of Charcot foot arthropathy following the increase in the prevalence of diabetes. The current gold standard of treatment is total contact casting for early deformity, but in recent years, surgery has been performed earlier in the disease process to create a clinically and radiographically plantigrade foot, with the aim of preventing or treating skin ulceration. This review article focused on types of surgical treatment and outcomes associated with each treatment option. Surgical correction consists of ostectomy, tendo-Achilles lengthening, soft tissue releases, and midfoot osteotomies. Arthrodesis can be performed with internal or external fixation or a combination of the two. The purpose of this review article is to review modern surgical techniques for the management of Charcot midfoot deformities. We searched PubMed, Embase, and the Cochrane Library databases using the following search terms: “Charcot arthropathy,” “neuroarthropathy,” “midfoot,” and “arthrodesis.” Articles were chosen based on relevancy to modern surgical treatment options for Charcot midfoot arthropathy. Internal fixation options include intramedullary column fixation, “beaming,” and superconstructs involving a combination of intramedullary fixation and plantar plating. An additional extramedullary construct is introduced, which involves placing large screws from the base of the metatarsal across the deformity, known as “rafting screws.” Complications of fixation methods are also discussed in detail.