Simple Exostectomy and Tarsal Tunnel Release for a Rocker Bottom Deformity in a Diabetic Charcot Arthropathy Foot—An Addition to the Eichenholtz Stage Classification of Charcot Arthropathy: A Case Report

Various nonsurgical modalities (total contact cast, braces, and custom-made foot orthosis) and surgical modalities (exostectomy, deformity correction, and arthrodesis) are described to treat the midfoot collapse causing rocker-bottom deformity in a diabetic foot with Charcot arthropathy. The Eichenholtz stage does not describe an acute presentation of chronic foot arthropathy with a midfoot ulcer and a rocker-bottom deformity. The author reports a 60-year-old diabetic woman with a long-standing nonhealing left midfoot ulcer and a rocker-bottom deformity with features of the acute stage (pain, swelling, warmth). Multiple surgeries were done elsewhere, but the ulcer persisted. A simple exostectomy, tarsal tunnel release (TTS), and customized footwear in the postoperative period healed the nonhealing ulcer and achieved a good functional outcome. This surgery achieves a sensate, stable, plantigrade foot, mitigating the shearing forces and focal areas of increased pressure that cause the midfoot collapse and nonhealing ulcers. An acute presentation in chronic midfoot arthropathy with an ulcer and rocker-bottom deformity needs a place and mention in the Eichenholtz stage classification of Charcot arthropathy as stage IV.