The development of a neuropathic ankle following successful correction of non-plantigrade charcot foot deformity. Journal Article

Author: Pinzur, M. S.
Article Title: The development of a neuropathic ankle following successful correction of non-plantigrade charcot foot deformity.
Abstract: BACKGROUND: The treatment of Charcot foot arthropathy has traditionally involved immobilization during the acute phase followed by longitudinal management with accommodative bracing. In response to the perceived poor outcomes associated with nonoperative accommodative treatment, many experts now advise surgical correction of the deformity, especially when the affected foot is not clinically plantigrade. The significant rate of surgical and medical-associated morbidity accompanying this form of treatment has led surgeons to look for improved methods of surgical stabilization, including the use of the circular ring external fixation. METHODS: Over a 7-year period, a single surgeon performed surgical correction of non-plantigrade Charcot foot deformity on 171 feet in 164 patients with a statically applied circular external fixator. Following successful correction, five patients developed a neuropathic deformity of the ipsilateral ankle after removal of the external fixator and subsequent weight bearing total contact cast. RESULTS: Three of the five patients progressed to successful healing of the neuropathic (Charcot) ankle arthropathy following treatment with a series of weightbearing total contact casts. Two underwent successful ankle fusion with retrograde locked intramedullary nailing. DISCUSSION: This unusual clinical scenario likely represents either a progression of the disease process in the foot or a complication associated with surgical correction of the original neuropathic foot deformity. A better understanding of this observation will likely become apparent as we acquire more experience with this disorder.
Keywords: Adult; Aged; Female; Humans; Middle Aged; Male; Retrospective Studies; Orthopaedic Surgery and Rehabilitation; IM; Bone Nails; Ankle Joint/pp [Physiopathology]; Ankle Joint/su [Surgery]; Arthropathy, Neurogenic/pp [Physiopathology]; Arthropathy, Neurogenic/su [Surgery]; Braces; Casts, Surgical; External Fixators/ae [Adverse Effects]; Foot Deformities/pp [Physiopathology]; Foot Deformities/su [Surgery]; Foot Joints/pp [Physiopathology]; Foot Joints/su [Surgery]; Joint Instability/pp [Physiopathology]; Joint Instability/th [Therapy]
Journal Title: Foot Ankle International
Volume: 33
Issue: 8
ISSN: 1071-1007; 1071-1007
Publisher: Unknown  
Journal Place: United States
Date Published: 2012
Start Page: 644
End Page: 646
Language: English
Notes: ID: 12629; Status: MEDLINE; Publishing Model: Journal available in: Print Citation processed from: Print; NLM Journal Code: 9433869, bxf