Hindfoot fusion with various auxiliary techniques in Charcot’s management

Abstract

Abstract Introduction: Management of Charcot’s arthropathy of the hindfoot (Sanders/Frykberg Type IV) is a challenging situation to address. Complex deformities linked with ankle/hindfoot Charcot’s disease are frequently multiplanar. Due to the collapse of the distal tibia and the two bones of the hindfoot, the talus, and calcaneus, the limb frequently shortens when the skeletal architecture is damaged. A varus ankle or heel results in increased lateral column plantar pressure of the foot due to changed foot pressure loading, predisposing the patient to develop lateral foot ulceration. Collapse and secondary avascular necrosis of the talus; additional stress on the injured bone exacerbates these deformities and contributes to ulcers in the foot, instability during walking, and limb-length discrepancy. Management: The primary indication for surgical ankle stabilization is a foot that cannot be braced and is unstable during walking. Other surgical indications include imminent ulceration, nonhealing ulcers, recurring ulcers, osteomyelitis, and/or severe pain. Achieving ankle and/or hindfoot arthrodesis and correcting these complex multiplanar deformities in this location stabilizes the hindfoot. Various auxiliary techniques that can be combined with Tibio-talo-calcaneal (TTC) are tricortical iliac crest graft and femoral head allograft to build hindfoot, plate augmentation, distally mobilized fibula as biological augmentation and multiple 6.5-mm screws. The choice between internal or exterior fixation is mostly determined by the presence or absence of an active infection and the quality of the bone. Conclusion: Surgical stabilization with TTC nail for Charcot’s arthropathy of the ankle and hindfoot is associated with good clinical outcomes. Despite the high likelihood of complications, limb salvage rates are between 80% and 90%. A meticulous selection of cases, a diligent multimodal strategy, and an experienced team are required to attain this result. Assessment of vascular status, glycemic control, optimum foot care, use of protective footwear during the acute inflammatory phase to prevent inadvertent trivial foot injuries, correction of calcium and vitamin D deficiencies, and cessation of tobacco and alcohol use are preoperative factors that can improve outcomes. Various auxiliary techniques can be combined with TTC nailing for optimum results.