Treatment of Charcot Foot Deformity by External Fixation – Questions and Challenges

Introduction:
Charcot syndrome in neuropathic diabetic foot causes severe multiplane deformities, leading later to formation of diabetic. early detection of Charcot and preventive treatment to avoid deformities is rare. Usually orthopedic surgeons deal with the stage of destruction of joints and stable or unstable deformities, often complicated by diabetic ulcers or bone infectionSeveral problems should be solved in planning and performing of operation. First – recognition of key joint deformity; ankle, subtalar, midfoot – where to perform first corrective osteotomy. Second – define the best practice for intraoperative bone infection management. Third – choose the best scheme of external fixator and technical approach for its application.

Materials and Methods:
During last two years we treated 8 patients with Charcot foot deformity. All of them had unstable ankle, subtalar joints or destructed midfoot. We applied corrective osteotomy for reduction of ankle joint, fixation by Steimann pins through calcaneus and tallus bones to tibia in corrected position after cartilage removal. Revision of midfoot in 3 cases presented deep bone infection with partial destruction. In those cases we apply “Bone alive” artificial bone substitute, promoting bone consolidation and preventing of infection due to acid pH. Also was applied preventive antibiotic therapy admitted according to infection specialist conclusion. In one case a talectomy

Results:
Those measures provided prevention of infection development in all 7 cases. Stable fixation of calcaneus, talus and tibia, treated and reduced joints of midfoot provide better conditions for operation and external fixation mounting. This scheme of treatment applied in 8 patients provided forming of plantigrade foot with normal axis and ability for ambulation without risk of diabetic ulcers development with closure of existed ulcers.

Conclusion:
True preoperative planning, stage intraoperative correction of deformities, preliminary fixation of ankle and subtalar joints, application of Bone Alive during operation provide better condition for operation and postoperative treatment.