Key Insights On Surgical Timing In Charcot Neuroarthropathy

By Eric A. Barp, DPM, and W. Ashton Nickles, DPM

A recent review article evaluated 14 published clinical series of midfoot, rearfoot and ankle arthrodesis procedures.27 These series comprised a total of 254 total procedures with 80.7 percent achieving radiographic fusion in approximately five months on average. Clinical stability, defined as “a stable foot on which a brace, shoe or both could be worn,” was obtained in 92.1 percent of these same subjects. In addition, the researchers reported a 26 percent rate of complications, which included infection, nonunion, malunion, amputation, stress fracture, fixation failure and recurrence of deformity.
A history of ulceration and concurrent ulceration increase the risks associated with surgical intervention but they are not an absolute contraindication. It has been reported that patients with Charcot neuroarthropathy and ulceration who undergo reconstruction have a 25 percent infection rate.28 The risk of non-healing ulceration also exists with one report citing that three out of 10 patients with ulceration at the time of reconstruction did not heal normally in the postoperative phase.29

Final Thoughts
Surgical intervention in the Charcot foot and ankle is becoming more common and much less restrictive. With the improvements in external fixation as well as the training of foot and ankle surgeons in these techniques, there are few limits when it comes to Charcot reconstruction.
Charcot neuroarthropathy remains a challenging clinical entity to treat not only due to its complexity but due to the associated diseases as well. In all cases, one must take proper patient selection and preoperative considerations into account. While difficult, these cases can be satisfying for the patient and surgeon alike.

Dr. Barp is a Fellow of the American College of Foot and Ankle Surgeons. He practices at the Iowa Clinic at Iowa Methodist Medical Center in Des Moines.

Dr. Nickles is the Chief Resident at Broadlawns Medical Center in Des Moines, Iowa.

Dr. Steinberg (pictured) is an Assistant Professor in the Department of Surgery at the Georgetown University School of Medicine inWashington, D.C.

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