Limb Salvage in Diabetic Charcot Arthropathy with Chronic Hindfoot Ulcer Using a Multimodal Conservative Approach

We report a case of a 60 year old male with uncontrolled type 2 diabetes, presenting with a Brodsky Type 2 Charcot foot and a chronic, 3 year old calcaneal ulcer complicated by osteomyelitis and polymicrobial infection. In contrast to the prevailing trend of primary amputation for such complex presentations, a limb salvage protocol was initiated. Management involved a standardized inpatient basal bolus insulin regimen for glycemic optimization, culture specific antimicrobials, and a “windowed” total contact cast (TCC) to balance gold standard offloading with wound access. A sequential, physiology based wound care strategy was employed: initial bed preparation with sharp debridement, followed by application of fish collagen during the initial dressings for accelerating healthy granulation, followed by recombinant human platelet derived growth factor to accelerate epithelialization. Complete ulcer re epithelialization and radiological consolidation of osteomyelitis were achieved within 4½ months. This case underscores the efficacy of a structured conservative approach. It highlights the utility of cost effective TCC modifications and sequential biologics as a viable alternative to amputation, particularly in resource constrained healthcare systems where the socioeconomic burden of limb loss is profound.