Modern Surgical Reconstruction Techniques for Midfoot Charcot Deformity

Surgical Treatment of Midfoot Charcot: Charcot arthropathy of the midfoot is a severe condition leading to substantial disability and morbidity. In cases where conservative management has been exhausted or deformity leads to or threatens foot ulceration, surgical treatment is typically recommended. Modern surgical treatment for midfoot Charcot arthropathy is varied, including exostectomies versus realignment, often with midfoot osteotomies and extended midfoot arthrodesis with internal fixation with screw fixation, beaming techniques, internal fixation with plates, and/or external fixation with circular frame applications. Techniques may be used in isolation or combined depending on the characteristics of the patient, presence of ulcers, or surgeon preference. Preoperative optimization with lowering of hemoglobin A1C when possible is paramount to reduce rates of perioperative complications. Despite these rates, complications after the surgical management of midfoot Charcot are high. There has been recent interest in the use of minimally invasive surgery techniques in the treatment of Charcot arthropathy in an effort to limit soft tissue dissection and reduce complications associated with surgery. Level of Evidence: Level V.