Introduction and purpose:Charcot neuroarthropathy defines a cluster of progressive lesions affecting the joints and bones, as well as the soft tissues of the foot in the context of diabetes, a pivotal role being attributed to peripheral neuropathy. Loss of sensation and proprioception, subsequent repeated trauma, muscle and autonomic nervous system impairment contribute to the alteration of the foot’s architecture and distribution of pressure, ultimately triggering ulceration and gangrene. The urge to avoid amputation has fueled the development of conservative and reconstructive techniques capable of delaying, if not preventing such negative outcomes. The purpose of this review was to present the most frequently used reconstruction procedures and the challenges arising in adapting them to particular foot morphologies and lesion stages. Methods:Literature search was conducted using PubMed, resulting in around 90 articles, multicenter studies and reviews, 26 of which were considered most relevant in providing the guidelines for orthopedic reconstruction and postoperative care in Charcot foot patients with diabetic neuropathy prevailing over arteriopathy. Results:The tarsometatarsal and metatarsophalangeal joints are most frequently affected. Closed reduction, arthrodesis, and tendon lengthening are key features of an efficient correction, alternatively accompanied by resections and tenotomies. Ulceration and callus debridement may also be necessary, while prolonged casting and immobilization remain obligatory. Conclusions:Most authors agree that stabilizing the deformities, optimizing the pressure on the soft tissues, and promoting the healing of potential lesions are the main purposes of the interventions. Prompt recognition and correction of Charcot foot deformities improve life quality and minimize the prospects of amputation.
4. Witzke KA, Vinik AI, Grant LM et al. Loss of RAGE defense: a cause of Charcot neuroarthropathy?. Diabetes Care. 2011; 34(7):1617-21.
5. Baumhauer JF, O’Keefe RJ, Schon LC et al. Cytokineinduced osteoclastic bone resorption in Charcot arthropathy: an immunohistochemical study. Foot Ankle Int. 2006; 27(10):797-800.
6. Harris JR, Brand PW. Patterns of disintegration of the tarsus in the anaesthetic foot. J Bone Joint Surg Br. 1966 Feb; 48(1):4-16.
7. Eichenholtz SN. Charcot joints. 1966, Springfield (IL): Charles C Thomas.
8. Schon LC, Easley ME, Weinfeld SB. Charcot neuroarthropathy of the foot and ankle. Clin Orthop Relat Res. 1998; 349:116-31.
9. Brodsky JW, Rouse AM. Exostectomy for symptomatic bony prominences in diabetic Charcot feet. Clin Orthop Relat Res. 1993; 296:21-6.
10. Sanders LI, Frykberg RG. The Charcot foot. In Levin and O’Neal’s The Diabetic Foot (7th edn), 2007, JH B, MA P (eds). Mosby Elsevier: Philadelphia, 258.
11. Sella EJ, Barrette C. Staging of Charcot neuroarthropathy along the medial column of the foot in the diabetic patient. J Foot Ankle Surg. 1999; 38(1):34-40.
12. Richter M, Mittlmeier T, Rammelt S, Agren PH, Hahn S, Eschler A. Intramedullary fixation in severe Charcot osteo-neuroarthropathy with foot deformity results in adequate correction without loss of correction - Results from a multi-centre study. Foot Ankle Surg. 2015 Dec; 21(4):269-76. doi:
15. Wukich DK, Raspovic KM, Hobizal KB, Sadoskas D. Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes. Diabetes Metab Res Rev. 2016 Jan; 32 Suppl 1:292-6. doi:
23. Pinzur MS, Gil J, Belmares J. Treatment of osteomyelitis in Charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation. Foot Ankle Int. 2012 Dec; 33(12):1069-74. doi:
24. Lavery LA, Armstrong DG, Boulton AJ. Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. J Am Podiatr Med Assoc. 2002; 92(9): 479-82.
25. Frykburg RG, Bowen J, Hall J, Tallis A, Tierney E, Freeman D. Prevalence of equinus in diabetic versus nondiabetic patients. J Am Podiatr Med Assoc. 2012; 102: N2 84-N2 88.
26. Tagoe MT, Reeves ND, Bowling FL. Is there still a place for Achilles tendon lengthening?. Diabetes Metab Res Rev. 2016 Jan; 32 Suppl 1:227-31. doi:
27. Rios-Ruh JM, Martin-Oliva X, Santamaría-Fumas A, Domínguez-Sevilla A, López-Capdevila L, Vilà Y Rico J, Sales-Pérez JM. Treatment algorithm for Charcot foot and surgical technique with circular external fixation. Acta Ortop Mex. 2018 Jan-Feb; 32(1):7-12.
28. Kučera T, Šponer P, Šrot J. Surgical reconstruction of Charcot foot neuroarthropathy, a case based review. Acta Medica (Hradec Kralove). 2014; 57(3):127-32. doi:
29. Scott JE, Hendry GJ, Locke J. Effectiveness of percutaneous flexor tenotomies for the management and prevention of recurrence of diabetic toe ulcers: a systematic review. J Foot Ankle Res. 2016 Jul 29; 9:25. doi:
30. Rasmussen A, Bjerre-Christensen U, Almdal TP, Holstein P. Percutaneous flexor tenotomy for preventing and treating toe ulcers in people with diabetes mellitus. J Tissue Viability. 2013 Aug; 22(3):68-73. doi:
32. Hong CC, Jin Tan K, Lahiri A, Nather A. Use of a definitive cement spacer for simultaneous bony and soft tissue reconstruction of mid- and hindfoot diabetic neuroarthropathy: a case report. J Foot Ankle Surg. 2015 Jan-Feb; 54(1):120-5. doi:
38. Jones CP, Youngblood CS, Waldrop N et al. Tibial stress fracture secondary to half-pins in circular ring external fixation for Charcot foot. Foot Ankle Int. 2014; 35:572-7.
39. Aragón-Sánchez J, Lázaro-Martínez JL, Quintana- Marrero Y, Álvaro-Afonso FJ, Hernández-Herrero MJ. Charcot neuroarthropathy triggered and complicated by osteomyelitis. How limb salvage can be achieved. Diabet Med. 2013 Jun; 30(6):e229-32. doi:
41. Tsourvakas S. Local antibiotic therapy in the treatment of bone and soft tissue infections. In: Danilla S, editor. Selected topics in reconstructive plastic surgery. Rijeka (Croatia): InTech Europe; 2012, 17-44.
42. Wiewiorski M, Yasui T, Miska M, Frigg A, Valderrabano V. Solid bolt fixation of the medial column in Charcot midfoot arthropathy. J Foot Ankle Surg. 2013 Jan-Feb; 52(1):88-94. doi:
43. Siebachmeyer M, Boddu K, Bilal A et al.Outcome of one-stage correction of deformities of the ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail. Bone Joint J. 2015; 97-B(1):76-82.