Background:Charcot neuroarthropathy (CN) involving both the hindfoot and midfoot represents a severe form of the disease and is often associated with significant instability, deformity, and an increased risk of ulceration. Although early-stage midfoot CN may be managed conservatively, combined hindfoot-midfoot involvement typically necessitates complex surgical reconstruction.Methods:This retrospective longitudinal case series included 21 consecutive patients with combined hindfoot and midfoot CN treated surgically at a tertiary care center in South India between 2019 and 2024. All procedures were performed by a single senior foot and ankle surgeon. Primary outcome was defined as limb salvage, operationalized as the achievement of an ulcer-free, plantigrade foot with autonomous ambulation at 12 months postoperatively.Results:The mean age of the cohort was 57.2 ± 8.2 years, with 14 of 21 patients (66.7%) being male. All patients (21/21, 100%) had Brodsky IV CN. Combined hindfoot-midfoot reconstruction was undertaken in 12 (57.1%), whereas 9 patients (42.9%) underwent isolated hindfoot reconstruction, with preservation of a stable or minimally involved midfoot to function as a pseudo joint at the level of the Chopart joint. Overall, metal hardware failure occurred in 2 (9.5%), with a mean time to implant breakage of 15.5 ± 3.5 months. Radiologic bony union was achieved in 16 of 21 hindfoot (76.2%) and 6 of 21 midfoot (28.6%). Recurrence of CN occurred in 1 (4.8%), contralateral CN in 3 (14.3%), and ulcer recurrence in 5 (23.8%). Limb salvage was achieved in all patients (21/21, 100%).Conclusion:Surgical reconstruction of combined hindfoot and midfoot CN was associated with 100% limb salvage and clinical outcomes in this single-center series; however, these findings should be interpreted cautiously given the small sample size and the high rates of surgical site infection (38.1%) and low midfoot bony union (28.6%) observed. Future research with larger cohorts and extended follow-up focusing on functional outcomes is needed to enhance understanding and optimize treatment strategies.Level of Evidence:Level IV, retrospective observational case series.

To determine the functional and radiographic outcomes, as well as complications, in patients diagnosed with Charcot neuroarthropathy (Sanders/ Frykberg types II, III, and IV; Eichenholtz stages II and III) treated with 1-stage arthrodesis using screw-based superconstructs, with a 1-year follow-up. Patients treated with the Caldiño method for Charcot neuroarthropathy who underwent 1-stage arthrodesis (panastragalodesis and triple arthrodesis) using screw-based superconstructs between January 2023 and August 2024 were followed. The visual analog scale (VAS) for pain were assessed preoperatively and postoperatively, clinical results and complications were analyzed along with patient satisfaction and the degree of radiographic consolidation at 1-year follow-up. Twenty-four patients were included, with equal sex distribution and a mean age of 54.5 years. The right foot was affected in slightly more than half of cases. Panastragalodesis was performed in the majority of patients, whereas the remaining patients underwent triple arthrodesis with preservation of the tibiotalar joint. A significant postoperative reduction in pain was observed, with mean VAS scores decreasing from 6.2 preoperatively to 0.7 at final follow-up. Radiographic evaluation demonstrated advanced consolidation in most patients. Minor postoperative complications were observed in fewer than half of the cohort and consisted primarily of superficial wound complications, all of which were managed conservatively and resolved within the early postoperative period. In this case series, screw arthrodesis, using superconstruction principles for the management of Charcot neuroarthropathy, was associated with satisfactory radiographic consolidation at 1-year follow-up, a substantial reduction in pain between pre- and postoperative periods, and the restoration of a stable, aligned, and pain-free plantigrade foot in patients with Eichenholtz stages II and III Charcot neuroarthropathy. Although complications did occur, minor wound-related complications were the most frequent and could be managed with conservative treatment, without the need for reintervention. Screw arthrodesis is a viable limb-sparing option in selected patients with advanced Charcot deformity. Level IV, retrospective case series.

The foot and ankle deformities associated with fibular hemimelia are considered the most complex aspect of the disease. The goal of treatment at the end of treatment for fibular hemimelia is a plantigrade foot. The main scope of the treatment before the last decade was amputation, which was thought to be the only option to provide the best functional outcome. Over the last two decades, many procedures have been published with variable outcomes. This article provides a focused review of the foot and ankle aspects of fibular hemimelia, along with multiple surgical options described in the literature and their associated outcomes.

Acute compartment syndrome of the leg is a well-documented orthopedic emergency; however, cases missed following open reduction and internal fixation (ORIF) of tibial plateau fractures are rarely reported. Delayed diagnosis can lead to severe sequelae such as foot deformity and functional impairment, posing significant challenges for rehabilitation. We report the case of a 41-year-old female presenting with chronic sequelae of missed compartment syndrome 6 months after ORIF for a Schatzker II tibial plateau fracture. Clinical presentation included progressive equinus deformity, ankle stiffness, loss of active dorsiflexion, sensory disturbance in the anterolateral leg and dorsum of the foot, and an inability to maintain a plantigrade foot during ambulation. The patient underwent a comprehensive late reconstruction strategy, comprising percutaneous Achilles tendon lengthening, common peroneal nerve release, deep flexor tendon release, and the Bridle procedure to restore active dorsiflexion. At the 6-year follow-up, the patient achieved a plantigrade foot, improved gait mechanics without equinus deformity, restoration of active dorsiflexion, and sensory recovery. The AOFAS Ankle-Hindfoot Scale score was 73/100, indicating good functional recovery. Missed compartment syndrome after ORIF of tibial plateau fractures can cause severe functional impairment if not recognized early. In chronic cases, a personalized reconstruction strategy combining tendon lengthening, nerve release, and tendon transfer can provide sustained functional improvement, even when intervention is delayed.

Background: Congenital Talipes Equinovarus (CTEV), or clubfoot, is a prevalent birth defect occurring in 1 in 1,000 live births. If untreated, it causes lifelong disability. This study evaluates the management and genetic research of clubfoot at the Government Coimbatore Medical College and Hospital (CMCH), India. Materials and Methods: A longitudinal study was conducted between 2011 and 2025 involving 581 children (345 male, 236 female) aged up to 10 years. Treatment followed the gold-standard Ponseti technique, utilizing serial casting and, where necessary, percutaneous tenotomy of the tendoachilles. Additionally, genetic analysis was performed on blood samples from 50 children to identify Single Nucleotide Polymorphisms (SNPs) in the PITX1 gene. Results: Out of 581 children, only 105 (18%) required surgical tenotomy to achieve a plantigrade foot, a significantly lower rate than other Indian studies (ranging from 84% to 100%). Genetic results identified 27 different SNPs. Specifically, the Chr5:135031277 C>T mutation was significantly associated with isolated clubfoot, being 2.26 times more likely to occur than previously reported pathogenic mutations in this population (P=0.0463). Discussion and Conclusion: The success of the CMCH model is attributed to early intervention, meticulous serial casting without limiting the number of applications, and dedicated parent counseling. The study demonstrates that the Ponseti technique remains highly effective in high-volume public health settings. Furthermore, the genetic findings suggest regional variations in the genetic "drivers" of clubfoot in the Indian demographic

Background: Early-presenting Congenital Talipes Equinovarus (CTEV) is usually corrected non-operatively with the Ponseti method, achieving excellent outcomes. Neglected CTEV (NCTEV), however, is challenging and often requires surgery. Objectives: These are to: 1) describe clinical profiles, reasons for neglect, and treatments among NCTEV presenting after walking age; 2) assess functional satisfaction, anatomical outcomes, and quality of life after treatment; 3) examine effects of age at presentation, deformity rigidity, and anaesthesia choice on outcomes; and 4) document common surgical complications. Methods: A retrospective descriptive cross-sectional review was conducted on NCTEV cases treated surgically at Usmanu Danfodiyo University Teaching Hospital, Sokoto (July 2018-June 2025). Patients included in the study were aged ≥2 years, had primary NCTEV with surgical treatment, complete records, and ≥9-month follow-up. Exclusion criteria were incomplete data, secondary clubfoot, and non-surgical care. Data (demographics, causes of neglect, Pirani score, prior care, operative details, post-operative care, complications, outcomes like plantigrade foot, ambulation, and cosmesis) were extracted using a structured form and analysed in SPSS version 25 (p Results: Of 126 surgical clubfoot patients, 58 (46%) met criteria, aged 3 - 23 years (mean = 13.9). Females were 65.5% (F:M = 1.9:1). A total of 103 feet were affected: 45 bilateral, 9 left, and 4 right. All presented with poor Pirani score (≥5.5). All had abnormal gait: 62.1% crawled; 37.9% walked on the dorsum. Deformities included equinus, cavus, varus, and adduction, with rigid hypoplastic feet being common. Main reasons for neglect were multi-factorial, with poor awareness (82.8%), socioeconomic barriers (79.3%), insecurity (62.8%), and limited access to care (72.4%). All had initial but failed non-operative care and underwent surgery and by 6 months, all walked erect largely with support; by 9 months, all walked independently. Subarachnoid block was accepted by 67% (≥8 years). Challenges included financial constraints (84.5%), long travel distance (63.8%), insecurity (69.0%) and low parental education (70.7%). Complications were infrequent and manageable. Conclusion: Tailored surgical management of NCTEV yields excellent functional and psychosocial outcomes. Age influences deformity severity and shared decision-making. Multi-factorial neglect necessitates early case finding, public education, and strengthened primary orthopaedic services to reduce NCTEV.

An infant with equino-varus deformity of her right foot and flexion deformity of the knee presented to our centre. Based on clinical and radiological examination findings, she was diagnosed with Paley Va (Jones Ia) axial longitudinal intercalary deficiency of the right leg as the entire tibia was absent. Consequent to cultural non-acceptance of amputation by the parents, her management involved staged procedures. The initial surgery aimed to achieve fusion between the talus and the distal end of the fibula after soft tissue release and fibular shortening. In the subsequent surgery, Weber patelloplasty comprising rotation of the patella distally by 90° and its fusion with the proximal fibula was performed. Complications included femoral osteomyelitis, skin necrosis and non-union at the site of the fibula and talus fusion, which were managed appropriately.Three years after the index procedure, the child has been walking with a stable, plantigrade foot, aided by a knee-foot-ankle orthosis and has a mobile knee joint with active movements. Although the reconstructed limb cannot be equated to a normal limb, the short-term outcomes show that reconstruction can be offered if parents do not consent for amputation and are willing to accept the prolonged duration of treatment.

Category: Ankle, OtherKeywords: Cavovarus Foot Deformity, Clinical Outcomes, Hindfoot DeformityIntroduction/Purpose: Complex foot deformities in skeletally mature patients, whether idiopathic or acquired, remain a challenge for foot and ankle and pediatric orthopedic surgeons. In low- and middle-income countries, approximately 78% of infants with clubfoot remain untreated due to barriers in healthcare access, resulting in rigid, multiplanar deformities that persist into adolescence or adulthood. These deformities often exhibit tense skin, hypertrophied tendon–ligament complexes, and muscle imbalance, making correction difficult. Standard reconstruction frequently requires extensive soft-tissue release, osteotomy, arthrodesis, or external fixation, all associated with morbidity and demanding rehabilitation. The Ponseti method is a cost- effective, minimally invasive standard for infants, however, its applicability in skeletally mature CFD remains unclear. This study evaluated a modified Ponseti-based serial casting protocol as a presurgical correction strategy for adolescent and adult CFD.Methods: A retrospective cohort study encompassing fifty-eight skeletally mature patients (78 feet) with idiopathic or acquired CFD treated with a modified PM between 2020 and 2024 was conducted. Patients were analyzed by etiology group, and deformity severity in cavus, varus, adductus, and equinus were recorded at baseline, after casting, and postoperatively. Repeated-measures analysis of variance and Tukey honestly significant difference testing compared changes across time points. Postoperative and casting complications, relapsed deformity, and the Foot and Ankle Outcome Score (FAOS) were reported at final follow-up.Results: Following casting, 55/58 (94.8%) of patients required adjunctive procedures. A plantigrade, shoable foot was achieved in 69/78 (88.5%) feet. Improvements in all deformity planes were primarily attributable to serial casting (p < 0.001), and, postoperatively, equinus improved significantly (p < 0.04 and p < 0.01) in both groups. Casting-related skin pressure injuries requiring wound care occurred in 9/78 feet (8.9%). After a median follow-up of 17 months, 10/78 feet (12.8%) relapsed. Postoperative complications included one wound dehiscence and one postoperative stiffness. Mean FAOS was 82.9 among respondents.Conclusion: A modification of the PM, using serial leg casting as a preoperative correction strategy for idiopathic and acquired CFD, reduces the need for, or the complexity of, major reconstructive foot surgery, achieving high rates of plantigrade feet with low rates of arthrodesis. This could redefine treatment paradigms in resource-constrained settings and for multiplanar correction of foot deformity.Flowchart of patient selection and study cohort derivation.Violin plot demonstrating the distributions of feet and magnitude of deformity across three time points.A 16-year-old female patient with bilateral congenital clubfoot. The right foot had previously undergone posteromedial release and external fixation. The left foot underwent Ponseti serial casting; after 10 casts, a neutral hindfoot and correction of cavus and forefoot adduction were achieved, followed by percutaneous Achilles tenotomy and tibialis anterior transfer to the lateral cuneiform with 6 weeks of immobilization. a,: pre-treatment clinical appearance of left foot and postoperative clinical appearance of fixator-treated right foot; b,c: after 10 casts; d: postoperative clinical appearance; e,g: clinical view after casting and after surgery; f,h: weight-bearing lateral X-rays showing better anatomic restoration of joint relationships after serial casting compared with the external fixator approachSubject #17: A 30-year-old patient with hemophilia and secondary ankle ankylosis presented to the Ponseti clinic with a CFD of the right foot. The patient was managed with 10 serial casts, achieving correction of the forefoot adduction, hindfoot varus, and cavus components. Residual equinus was addressed with tibiotalar arthrodesis. a,b: pre-casting clinical appearance; c: preoperative ankle radiograph; d: postoperative lateral radiograph; e: immediate postoperative clinical appearance; f,g: follow-up clinical appearance demonstrating correction of the deformity.A 67-year-old patient with bilateral congenital clubfeet previously treated with posteromedial release presented to our clinic with relapse. Initial management consisted of 16 serial casts followed by percutaneous Achilles tenotomy, TATT, and plantar fasciotomy. a,b: Initial position of feet; c.d: Initial lateral X-rays; e,f: Postoperative clinical appearance; g,h: weight-bearing lateral X-rays showing adequate joint relationship.

Tibial hemimelia (TH) is a rare congenital condition characterized by partial or complete absence of the tibia, often associated with limb shortening, foot deformities, and joint instability. Due to its rarity and variability, optimal management is challenging. We report a long-term follow-up of a female patient with type II tibial hemimelia (Jones classification) and type IVA (Paley classification). We performed staged reconstructive surgery, including tibiofibular synostosis, centralization of the foot, multiple Ilizarov limb lengthening procedures, and correction of knee valgus and foot deformities. Four lengthening procedures were performed between ages 3.5 and 16 years, achieving a total tibial lengthening of 23 cm. Complications included supracondylar femoral fracture and regenerate fracture, both managed conservatively or with pin fixation. At age 25, clinical evaluation showed a stable knee with a range of motion of 0–120°, a plantigrade foot, normal limb alignment, and a residual limb-length discrepancy of 2 cm. The patient reported lower intensity pain and no need for orthoses. Health-related quality of life, as assessed using the Limb Deformity--Scoliosis Research Society (LD-SRS) questionnaire, demonstrated high scores for treatment satisfaction (4.07/5), function (4.14/5), and pain (4.00/5), with slightly lower scores in mental health (3.80/5). Pain, if it occurs, presents as burning lumbar pain, deep radiating pain in the left hip and right knee, and tingling pain in the right foot. Multistage reconstructive surgery combined with distraction osteogenesis can provide satisfactory functional and cosmetic outcomes in severe tibial hemimelia, enabling near-normal limb length and alignment, stable joints, and good patient-reported quality of life.

Cole Osteotomy and Variations.

To maintain a plantigrade foot, knee deformity prompts compensatory hindfoot deformity. TKA realigns the knee correcting hip-knee angle (HKA) However, the consequential impact of severe varus on ankle and foot has been inadequately investigated in contemporary literature. The study consisted of 66 patients (87 knees) who underwent TKA. The radiological parameters assessed were hip-knee angle (HKA), tibial plafond inclination angle (TPIA), tibio-talar tilt angle (TTTA) and talar inclination angle (TIA). Functional assessment was done with AOFAS score pre-operatively and at 2-year follow-up. The paired t test and Pearson's correlation tests were used for statistical analysis. HFA, TPI, TTT, and TIA post-TKA showed statistically significant correction (p < 0.001 for all parameters). On correlating HKA with hindfoot alignment, for physiological HFA ≤ 6 degrees, the mean correction in HFA was 2.55 degrees (r = 0.668, p < 0.001) and for abnormal HFA > 6, the mean correction in HFA was 6.47 degrees (r = 0.355, p = 0.029). On correlating correction of ankle alignment with correction in HKA, correction in TPI (r = 0.04, p = 0.713), TTT (r = -0.017, p = 0.874), TIA (r = 0.158, p = 0.144) was not statistically significant. Significant improvement in AOFAS was seen post-TKA with a mean increase from 72.0 to 88.9 (p < 0.001). TKA improves ankle and hindfoot alignment both radiologically and functionally. However, any persistent malalignment in the ankle and hindfoot can lead to patient dissatisfaction.

To explore the effectiveness of QIN Sihe's surgical strategy combined with Ilizarov technique in treating foot and ankle deformities on the verge of amputation. A retrospective analysis was conducted on the clinical data of 56 patients (62 feet) with foot and ankle deformities on the verge of amputation treated with QIN Sihe's surgical strategy and Ilizarov technique between May 2010 and December 2020. Among them, there were 39 males and 17 females. The age ranged from 8 to 62 years (median, 27.5 years). QIN Sihe's surgical strategy: subcutaneous release or open lengthening of contracted Achilles tendons, limited correction of bony deformities through multiple osteotomies during surgery, tendon transfer to balance the power of the foot and ankle, simultaneous percutaneous osteotomy and correction of tibial torsion deformity to restore the weight-bearing line of the lower extremity, and installation of Ilizarov foot and ankle distraction devices for slow distraction and correction of residual foot and ankle deformities. After removal of external fixation, individualized braces were used for protection during exercise and walking. For patients with bilateral deformities, staged surgeries were performed. The effectiveness was evaluated according to the QIN Sihe's Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction at last follow-up. All patients achieved the preoperative expected orthopedic and functional reconstruction goals. The postoperative wearing time of external fixator was 3-7 months, with an average of 5.5 months. The incidence of pin tract infection during the treatment period was 6.5% (4/62). All patients were followed up 25-132 months (median, 42 months). All 56 patients successfully retained their limbs. At last follow-up, foot and ankle deformities were corrected, the weight-bearing line was basically restored, and plantigrade feet were restored. At last follow-up, according to QIN Sihe's Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction, the effectiveness was rated as excellent in 37 cases (39 feet), good in 18 cases (21 feet), and fair in 1 case (2 feet). The excellent and good rate was 96.8% (60/62). The combination of QIN Sihe's surgical strategy and Ilizarov technique in treating foot and ankle deformities on verge of amputation is minimally invasive, safe, and the therapeutic effect is controllable. This combined approach has unique advantages in preserving limb function and restoring biomechanical balance.

To evaluate the effectiveness of correcting post-traumatic equinovarus deformity using Ilizarov external fixation technique combined with limited osteotomy. A retrospective analysis was conducted on clinical data from 29 patients with post-traumatic equinovarus deformity treated between July 2018 and March 2023. The cohort included 18 males and 11 females, with ages ranging from 15 to 57 years (mean, 24.3 years). All patients exhibited ankylosed ankle joints with equinovarus deformity. During surgery, external fixators were installed according to Ilizarov pinning principles, and minimally invasive osteotomy was performed at the ankle joint. Concurrently, soft tissue release was achieved via minimally invasive Achilles tendon lengthening. Postoperatively, multiplanar deformity correction was accomplished through gradual adjustment of the external fixator. The fixator was removed after bony union at the osteotomy site, followed by bracing. The surgical duration, intraoperative blood loss, fixator wear time, and complications were recorded. Postoperative outcomes included assessment of deformity correction and bony union at the osteotomy site. Functional improvement and pain relief were evaluated using pre- and post-operative scores from the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) score. All 29 patients were followed up 12-24 months (mean, 18 months). The mean surgical duration was 85.6 minutes, with a mean intraoperative blood loss of 110 mL. Full deformity correction was achieved within 26-80 days (mean, 40.7 days) through progressive fixator adjustments. At correction completion, all ankles restored to a neutral or 5°-10° dorsiflexed position with plantigrade foot function. Superficial pin tract infections occurred in 3 patients (10.3%), resolved with local wound care, enhanced nursing, and oral antibiotics. No deep or systemic infections was observed. One patient sustained a calcaneal half-pin fracture due to a fall during fixator wear, but no bone fragment displacement occurred. No vascular or neurological complication was reported. Complete bony union was achieved at all osteotomy sites without nonunion. At last follow-up, the AOFAS ankle-hindfoot score improved from preoperative 42.7±8.7 to postoperative 65.7±9.3, and the VAS score decreased from preoperative 4.5±1.3 to postoperative 2.5±1.1, with significant differences ( P<0.05). Functional outcomes were rated as excellent in 14 cases, good in 13 cases, fair in 1 case, and poor in 1 case, with an excellent and good rate of 93.1%. The progressive correction strategy combining Ilizarov external fixation technique with limited foot osteotomy effectively corrects post-traumatic equinovarus deformity while preserving soft tissue integrity. This method is associated with minimal, largely controllable complications and achieves alignment stability and fusion outcomes comparable to traditional open surgery, making it an effective treatment for complex foot and ankle deformities.

Midfoot Charcot Surgical Algorithm to Restore the Tripod Foot Configuration.

New Surgical Techniques in the Treatment of Charcot Neuroarthropathy Deformities.

ObjectiveThe objective of this study was to evaluate the clinical and radiographic outcomes of children with congenital clubfoot following treatment with the Ponseti method.MethodsWe conducted a retrospective analysis of radiographic data from 20 children (12 males and 8 females) aged between 2 years 6 months and 7 years who underwent Ponseti method treatment for congenital clubfoot. The beginning treatment age was below 4 weeks after birth. The study included bilateral ten cases and unilateral ten cases. There were 20 cases which age matched normal feet in control group. The Pirani scoring system was used to assess the severity of the clubfeet. The average Pirani score was 5.5 (4.5–6). Radiographic measurements were taken from post-treatment images and compared to normative values. Talar length, talar height, calcaneus inclination angle, Meary's angle, and talocalcaneal angle were measured. Paired t-tests and effect size (r) were used to evaluate the effectiveness of the treatment.ResultsAll the patients were followed up at average 44 months (30–84 months). Functional, plantigrade feet with adequate mobility were achieved in all patients. The average Pirani score was 0.075 (0–0.5) at the end of the follow- up. Bilateral clubfoot exhibited significantly shorter talar length, lower talar height, smaller talocalcaneal angles, smaller calcaneus inclination angles and smaller Meary's angles compared to normal feet. Unilateral clubfeet exhibited a significantly greater talar height and a slightly higher calcaneus inclination angles compared to bilateral clubfeet. There were no significant differences observed in talar length, talocalcaneal angle, or Meary's angle between bilateral and unilateral clubfoot groups.ConclusionsThe Ponseti method has been proven to be highly effective in achieving functional correction in children with congenital clubfoot. However, radiographic images in this study revealed differences in tarsal bone morphology. Therefore, further long-term studies are necessary to evaluate the durability of these corrections and their impact on functional mobility in adulthood. The future study should also aim to clarify the causes of observed morphological alterations.

A chronic, non-infectious degenerative disease of the foot and ankle joints, Charcot neuroarthropathy (CN) is frequently linked to peripheral neuropathy and diabetes mellitus. Joint dislocation, fractures, and deformities are its hallmarks, and they can result in serious side effects such ulceration, osteomyelitis, and limb amputation. We report the case of a 53-year-old woman who was diagnosed with a neglected talus fracture and had a 23-year history of limping due to type 2 diabetes mellitus. Clinical and radiological evaluations revealed a fixed 130° equinus deformity and extensive midfoot and hindfoot destruction, consistent with Eichenholtz Stage III Charcot joint. The patient underwent a triple arthrodesis procedure, combining debridement, osteotomy, and internal fixation using cannulated and cancellous screws, along with autologous bone graft harvested from the iliac crest. Post-operative management included non-weight-bearing mobilization and casting in a plantigrade position. Radiographic follow-up at three months showed stable fusion, proper alignment, and no signs of implant failure. Clinically, the patient reported reduced pain and improved function, with the ability to perform daily activities with minimal assistance. This case highlights the importance of timely diagnosis and appropriate surgical intervention in advanced CN to prevent further deformity and preserve limb function. Triple arthrodesis proved effective in restoring foot alignment and achieving a stable, plantigrade foot. Patient compliance and individualized treatment planning, considering comorbidities, are crucial for optimal outcomes in managing Charcot arthropathy. Keywords: Charcot neuroarthropathy, triple arthrodesis, diabetes mellitus, hindfoot deformity.

BackgroundIn Charcot neuro-osteoarthropathy (CNO), deformity-induced ulcers significantly increase the risk of amputation. Reconstructive foot surgery (RFS) is essential to prevent this, but peripheral artery disease (PAD) and diabetes increase complication risks.MethodsAll patients from a single center treated with RFS for midfoot CNO between 2019 and 2023 were included. Treatment followed a multidisciplinary protocol aimed at optimizing 4 factors: hyperglycemia, infection, pressure, and arterial blood flow.ResultsSeventeen patients were included (mean follow-up 20 months). Sixteen patients (94%) achieved an ulcer-free, plantigrade foot. No amputations were performed. Fifteen patients (88%) were diabetic, 67% of whom had elevated HbA1c levels, and 80% of these normalized after treatment. Four patients had PAD (24%), of whom 2 required revascularization. Deep infections occurred in 4 (24%) cases, and 6 (35%) required additional surgery.ConclusionsUlcer-free and good functional outcomes can be achieved, and amputation prevented, in patients with midfoot CNO provided they are treated by a multidisciplinary team.Level of Evidence:Level IV, case series.

A young boy in his early childhood was diagnosed with a flail left plano-valgus foot with a tendo-achilles contracture. After ruling out multiple potential treatment options, the surgery chosen was an extra-osseous talotarsal stabilisation device insertion into the subtalar joint with tendo-achilles lengthening. The child's foot was then immobilised for 3 weeks in a below-knee plaster of Paris slab. No intraoperative or postoperative complications were noted. The child can now walk with a plantigrade foot. Being an orthopaedic surgeon often requires us to think outside the box and be familiarised with the armamentarium available at our disposal.

Background: Distal tibial osteotomy is used in the treatment of ankle deformities. Many methods of fixation of this osteotomy were described, including plates, pins, and ilizarov. Dome osteotomy is a cylindrical osteotomy with no bone loss, with the axis of bone is rotated around the center of the circle. We conducted a case series of treatment of ankle deformity due to malunited ankle fusion with distal tibial dome osteotomy. Methods: Eight patients with a history of poliomyelitis with ankle deformity due to a malunited ankle fusion underwent distal tibial dome osteotomy with ilizarov fixation for deformity correction. Postoperative follow up was done up to 12 months postoperatively. We intended to follow up the union of the osteotomy, the axis of the limb, the external clinical appearance, and patient satisfaction. Results: Deformity correction was achieved in all patients regarding the clinical alignment, with no apparent clinical residual deformity in coronal, sagittal plane, or rotational deformity, the limb was cosmetically straight with a plantigrade foot satisfactory to the patients with improving quality of gait. The osteotomy fully united in all patients in a period of 8 to 11 weeks with an average of 9.3 weeks, after which frame was removed. No patient had nonunion or delayed union of the osteotomy. Three patients had pin tract infection during the period of the fixator which was treated by local dressings and antibiotics. Conclusion: Distal tibial focal dome osteotomy fixed by ilizarov is an effective treatment option in malunited ankle fusion deformities.