Clin Orthop Surg.  2019 Dec;11(4):459-465. 10.4055/cios.2019.11.4.459.

Results of Simple Conservative Treatment of Midfoot Charcot Arthropathy

• Kim YK
• Lee HS
• Seo SG
• Park SH
• Boedijono

• KMID: 2462541
• DOI: http://doi.org/10.4055/cios.2019.11.4.459

Abstract

BACKGROUND
Traditionally, conservative management with an offloading orthosis, such as total contact cast (TCC), has been the standard of care for midfoot Charcot arthropathy. Considering complications of TCC and surgery, we treated midfoot Charcot arthropathy without TCC in our patients. The purpose of this study was to report clinical and radiological outcomes of conservative management of midfoot Charcot arthropathy.
METHODS
A total of 34 patients (38 feet) who were diagnosed as having midfoot Charcot arthropathy between 2006 and 2014 were included. Patients started full weight bearing ambulation in a hard-soled shoe immediately after diagnosis. Outcomes such as progression of arch collapse, bony prominence, ulcer occurrence, limb amputation, and changes in Charcot stage were evaluated.
RESULTS
Of 38 feet, arch collapse was observed in four while progression of bottom bump of the midfoot was observed in five feet. Foot ulcers related to bony bumps were found in two feet.
CONCLUSIONS
Conservative treatment without restriction of ambulation is recommended for midfoot Charcot arthropathy because it is rarely progressive, unlike hindfoot-ankle arthropathy. In some cases, simple bumpectomy can be required to prevent catastrophic infection.

Keyword

Charcot joint; Conservative treatment

MeSH Terms

Amputation
Arthropathy, Neurogenic
Diagnosis
Extremities
Foot
Foot Ulcer
Humans
Orthotic Devices
Shoes
Standard of Care
Ulcer
Walking
Weight-Bearing

Figure

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  Fig. 1 With reference to the baseline (white line), the position change of the bottom bump in the initial and final foot lateral radiographs was assessed (arrow).

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  Fig. 2 A gross photo of a bump-related skin ulcer lesion on the plantar surface in a patient who underwent below-knee amputation.

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