title: Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes.
abstract: BACKGROUND
  Charcot neuroarthropathy (CN) of the ankle and hindfoot (Sanders/Frykberg Type IV) is challenging to treat surgically or nonsurgically. The deformities associated with ankle/hindfoot CN are often multiplanar, resulting in sagittal, frontal and rotational malalignment. In addition, shortening of the limb often occurs from collapse of the distal tibia, talus and calcaneus. These deformities also result in significant alterations in the biomechanics of the foot. For example, a varus ankle/hindfoot results in increased lateral column plantar pressure of the foot, predisposing the patient to lateral foot ulceration. Collapse of the talus, secondary to avascular necrosis or neuropathic fracture, further accentuates these deformities and contributes to a limb-length inequality.
  The primary indication for surgical reconstruction is a nonbraceable deformity associated with instability. Other indications include impending ulceration, inability to heal an ulcer, recurrent ulcers, presence of osteomyelitis and/or significant pain. Arthrodesis of the ankle and/or hindfoot is the method of choice when surgically correcting CN deformities in this region. The choice of fixation (i.e. internal or external fixation) depends on largely on the presence or absence of active infection and bone quality.
  
  
  CONCLUSIONS
  Surgical reconstruction of ankle and hindfoot CN is associated with a high rate of infectious and noninfectious complications. Despite this high complication rate, surgeons embarking on surgical reconstruction of ankle and hindfoot CN should strive for limb salvage rates approximating 90%. Preoperative measures that can improve outcomes include assessment of vascular status, optimization of glycemic control, correction of vitamin D deficiency and cessation of tobacco use.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
authors.affiliation: Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, WA, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Raspovic
authors.affiliation: Podiatric Surgery Program, Heritage Valley, Beaver, PA, USA.
authors.forename: Kimberlee B
authors.initials: KB
authors.lastname: Hobizal
authors.affiliation: Fellow Reconstruction and Limb Salvage Surgery UPMC Mercy Hospital, Pittsburgh, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Sadoskas
mesh_terms: D000842:Ankle / Q000473:pathology / Q000601:surgery*; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000639:trends; D003226:Congresses as Topic; D003663:Decision Trees; D017719:Diabetic Foot / Q000150:complications / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000150:complications / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery*; D019317:Evidence-Based Medicine; D016267:External Fixators / Q000009:adverse effects / Q000639:trends; D005531:Foot Deformities, Acquired / Q000150:complications / Q000473:pathology / Q000534:rehabilitation / Q000601:surgery; D006365:Heel / Q000473:pathology / Q000601:surgery; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects / Q000639:trends; D023821:Limb Salvage / Q000009:adverse effects* / Q000639:trends; D057285:Precision Medicine; D011300:Preoperative Care / Q000009:adverse effects / Q000639:trends; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000639:trends; D035703:Therapies, Investigational / Q000009:adverse effects / Q000639:trends
keywords: Charcot; ankle; diabetes; hindfoot; reconstruction; surgery