Current surgical interventions of Charcot neuroarthropathy of the foot and ankle: a systematic review

Abstract

Introduction: Charcot neuroarthropathy (CN), also known as Charcot's foot, is consequently causing a reduction in quality of life, high disability, and an increased risk of mortality that poses many clinical challenges in its diagnosis and management. Common surgical interventions typically include ulcer debridement, exostectomy, deformity correction, and minor and major amputations. Methods: This systematic review was conducted using the PRISMA guideline. Literature research incorporating PubMed/ MEDLINE database for English language studies published in the last 5 years with the key terms defined using the PICO framework, which includes: Charcot, neuroarthropathy/arthropathy, neurogenic, and surgery, which were used interchangeably. A further set of keywords within the topic were then identified, including ankle, hindfoot, foot, fore-foot, and mid-foot. Result: 221 feet undergone surgical reconstruction. Bony fusion occurred in 154 of 221 feet (71%), 79 of 128 feet (62%) in internal fixation, 47 of 58 feet (81%) in external fixation, and 29 of 34 feet (85%) in the utilization of both internal and external fixation. Conclusion: Charcot neuroarthropathy poses many clinical challenges in its diagnosis and management. Many experts have proposed the implementation of different strategies to manage this complex condition depending on the acute and chronic phases of its nature. Delayed diagnosis can result in a severe deformity that can act as a gateway to ulceration, and infection and, in the worst case, can lead to limb loss. Further studies aimed at determining selection criteria and treatment algorithms are required for greater standardization of outcomes.