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Charcot Arthropathy of Foot and Ankle: Radiographic and Clinical Patterns with Related Outcomes

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Abstract

Purpose

Our aim is to retrospectively review and evaluate the patterns of affection of Charcot arthropathy of foot and ankle.

Methods

Two hundred twenty-eight patients (235 feet) with post-acute Charcot were reviewed and classified anatomically through plain radiographs into type I and type II based on single or multiple regions affected, respectively. Type I included ankle, Lisfranc (tarsometatarsal), naviculocuneiform, forefoot, and hindfoot which includes one of the following: talonavicular joint, calcaneocuboid joint, or calcaneus. Type II included peritalar, perinavicular, mid-tarsal Charcot, or any other combination. Both types were further classified into four stages (A, stable with no deformity; B, stable with deformity; C, unstable; and D, deformity/instability with associated mechanical ulcers).

Results

The most common type was type IIC (27.2%) followed by type IID (18.3%), while types IA and IIA represented the least common types (3.4% and 3.8%, respectively). Types IA and IIA were managed conservatively. All patients in types IC, ID, IIB, IIC, and IID and the majority of type IB received fusion surgery to achieve stability and correction of deformity. Type II D had the highest complication rate (30%). Five patients ended up with amputation, and all were stage IID.

Conclusion

Affection of single region has better prognosis than affection of two or more regions. Stage A has the best prognosis and can be managed conservatively provided good diabetes control. Surgery is indicated in all cases of types IC, ID, IIB, IIC, and IID to achieve stability and correction of deformity and prevent complications. Mechanical ulcer (stage D) carries the worst prognosis and highest complication rate.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Hani El-Mowafi, Mohamed Abdelaziz Elghazy, Yasser R. Kandil, Samer Ali, Ahmed El-Hawary & Mazen S. Abulsaad

  2. Department of Orthopedic Surgery, Mansoura University Hospital, 12 El-Gomhoriya Street, Mansoura, 35516, Dakahliya, Egypt

    Mohamed Abdelaziz Elghazy

Authors
  1. Hani El-Mowafi
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  2. Mohamed Abdelaziz Elghazy
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  3. Yasser R. Kandil
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  4. Samer Ali
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  5. Ahmed El-Hawary
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  6. Mazen S. Abulsaad
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Correspondence to Mohamed Abdelaziz Elghazy.

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IRB approval was obtained from Faculty of Medicine-Mansoura University prior to conducting the study.

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Level of Evidence: level IV case series 

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El-Mowafi, H., Elghazy, M.A., Kandil, Y.R. et al. Charcot Arthropathy of Foot and Ankle: Radiographic and Clinical Patterns with Related Outcomes. International Orthopaedics (SICOT) 45, 2201–2208 (2021). https://doi.org/10.1007/s00264-021-05082-6

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  • DOI: https://doi.org/10.1007/s00264-021-05082-6

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