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RESPONSES/COMMENTS (CLINICAL)

08/20/2012     




RE: Chronic Charot Foot (Stephen S Pirotta, DPM)
From: Tip Sullivan, DPM

I have a very simple approach to Charcot neuroarthropathy, assuming that this is in a quiescent phase and not infected. I look at them as STABLE or UNSTABLE. The stable Charcot foot is fairly easily accommodated, even if it is significantly deformed. The unstable Charcot foot is the really tough one. The surgical goal that one should keep in mind is changing an unstable to a stable foot and avoiding the obvious sequelae. If reconstructive surgery is not a reasonable option (risks >>benefit), then ablative surgery is certainly reasonable.

I do not think that removal of the entire cuboid would be necessary. In fact, it might add to the instability and those associated problems. I would simply aggressively remove the prominent bone—and then remove a little more—making sure that the peroneus longus was either grafted to the brevis or re-attached to the lateral foot. A TAL is a MUST DO. Forget the gastroc on this one. I would also bet that this patient is obese and would make sure I talked with the “team” member that could make sure that this patient was metabolically maxed out. Using a wheelchair post-op is not a bad idea.

Tip Sullivan, DPM, Jackson, MS, tsdefeet@MSfootcenter.net