Is Rocker Bottom Reconstruction A Viable Option For Limb Preservation?

By Scott Neville, DPM, Peter Blume, DPM, and Jonathan Key, DPM

   Although Charcot neuroarthropathy occurs in a small percentage (5 percent) of the diabetic population, the natural disease course is associated with severe morbidity including chronic ulcerations, infections and amputations.1 The medical necessity of limb preservation is well known to all podiatrists. However, the recent advent of rocker bottom reconstruction provides the podiatric surgeon with another tool in the fight for limb preservation.    Those with ulcerations secondary to Charcot foot deformity are part of a complex subset of patients who require a multidisciplinary approach. The physician who intends to treat Charcot ulcerations successfully must have knowledge of podiatric surgery, plastic surgery and infectious disease, not to mention endocrinology, neurology, cardiology and vascular surgery just to name a few. Over the past decade, the focus of treatment has shifted away from prolonged conservative wound care toward surgical reconstruction with plastic surgery closure of ulcerations.    A plethora of plastic surgery techniques have been described in the literature. A partial list includes rotational, advancement, pedicle and free flaps. Although these plastic techniques may initially accomplish wound closure, when they are used in isolation, they fail to address the underlying etiology of the ulceration. The root cause of the Charcot ulceration is increased pressure secondary to osseous deformity and concomitant biomechanical flaws. If one does not address this underlying etiology, a flawlessly executed plastic surgery closure or conservative wound care is doomed to fail. This logic has led to the advent of both osseous and soft tissue Charcot reconstruction.

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