Early Staged Surgical Reconstruction for Active Midfoot and Ankle Charcot’s Neuroarthropathy

BACKGROUND: Charcot's neuroarthropathy (CN) is a destructive inflammatory process that affects patients with peripheral neuropathy, most commonly those with uncontrolled diabetes mellitus. The disease progresses through an active hyperemic phase that eventually becomes inactive, and the affected bone consolidates. The period in which the disease progresses from active to inactive is when instability, deformity, dislocation, and ulceration may occur depending on what deforming forces are stressing the affected pathologic area. There is a paucity of literature to support early primary surgical intervention, either single or staged, for active CN. METHODS: The purpose of this case series was to retrospectively review 30 reconstructions in 30 patients who underwent primary surgical intervention for active midfoot and ankle CN. All of the 30 patients underwent staged deformity correction with temporary circular ring external fixation followed by definitive internal fixation. RESULTS: Twenty-seven of the staged reconstructions (90%) at final follow-up resulted in limb salvage with no minor amputations after reconstruction. Mean final follow-up was 24.4 months. Nine of the 30 patients (30%) did not remain ulcer-free; however, 50% of the patients had a preexiting ulceration before surgical intervention, and the cohort exhibited a 40% healing rate of ulcers. CONCLUSIONS: We achieved a 90% limb salvage rate in patients with active midfoot and ankle CN with a staged surgical intervention protocol. Surgical intervention in the active stage of CN may be beneficial for patients who have gross instability with ulceration, significant midfoot collapse, and frank dislocation.