Our Foot and Ankle Surgeons specialize in computer assisted external fixation mediated correction and beaming techniques for treatment of acute and chronic Charcot ankle and foot deformities
What is Charcot Arthropathy?
Charcot foot or ankle is a condition stemming from weakening of the bones in the foot and ankle that can occur in people who have significant neuropathy, mostly seen with Diabetes. The bones are weakened enough to fracture, and with continued walking, the foot eventually changes shape. As the condition advances, the midfoot and/or ankle joint collapse and the foot and ankle takes on abnormal shape–a rocker-bottom foot or a dislocated ankle.
Charcot foot or ankle develops as a result of neuropathy, which decreases sensation and the ability to feel temperature, pain or trauma. Because of diminished sensation, affected individuals continue to walk, making the injury worse.
The symptoms of Charcot ankle or foot may include:
- Warmth to the touch
- Redness of the foot
- Swelling in the area
- Pain or soreness
Early diagnosis of Charcot Arthropathy is extremely important for successful treatment. To arrive at a diagnosis, the surgeon will examine the foot and ankle and ask about events that may have occurred prior to the symptoms. X-rays and other imaging studies including MRI and/or CT and various blood tests may be ordered.
Complete nonweightbearing is necessary to keep the foot or ankle from further collapsing. The patient will not be able to walk on the affected foot until the doctor determines it is safe to do so. During this period, the patient may be fitted with a cast, removable boot or brace and may be required to use crutches or a wheelchair. Custom shoes and bracing may be necessary for long-term management. A modification in activity level may be needed to avoid repetitive trauma to both feet. A patient with Charcot in one foot is more likely to develop it in the other foot, so measures must be taken to protect both feet.
When Is Surgery Needed?
When casting is not effective, application of external fixation is very helpful in both offloading and bracing the foot and ankle bones so they do not collapse further. Once stable, small deformities may be managed with resection of the prominence. However, large deformities, collapse of the midfoot or dislocation of the ankle joint need to be addressed in a comprehensive and often, staged manner. First, an external fixation construct such a butt or miter frame is applied. Computer software is utilized to gradually correct the deformities, typically over a course of 4-6 weeks. Once this is complete, beaming of the foot, ankle and leg bones are performed utilizing large diameter screws, bolts and intramedullary nails to hold the correction.