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The Neuropathic (Charcot) Ankle

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Evaluation and Surgical Management of the Ankle

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Abstract

The neuropathic (Charcot) ankle generally develops following an ankle fracture in the insensate diabetic. Outcomes are far worse than neuropathic deformity of the midfoot. The goal of this chapter is to provide a framework for treating this very complex problem.

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References

  1. Rogers LC, Frykberg RG, Armstrong DG, Boulton AJM, Edmonds M, Ha Van G, Hartemann A, Game F, Jeffcoate W, Jirkovska A, Jude E, Morbach S, Morrison W, Pinzur M, Pitocco D, Sanders L, Wukich DK, Uccioli L. The diabetic Charcot foot syndrome: a report of the joint task force on the Charcot foot by the American Diabetes Association and the American podiatric medical association. Diabetes Care. 2011;34:2123–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Jones C, McCormick J, Pinzur MS. Surgical treatment of Charcot foot. In: instructional course lectures of the American Academy of Orthopaedic Surgeons. 67: 255–267, 2018.

    Google Scholar 

  3. Pinzur MS, Schiff AP. Deformity and clinical outcomes following surgical correction of Charcot foot: a new classification with implications for treatment. Foot Ankle Int. 2018;39(3):265–70.

    Article  PubMed  Google Scholar 

  4. Sammarco VJ, Sammarco GJ, Walker EW, Guiao RP. Midtarsal arthrodesis in treatment of Charcot midfoot arthropathy. J Bone Joint Surg. 2009;91(1):80–91.

    Article  PubMed  Google Scholar 

  5. Ford SE, Cohen BE, Davis WH, Jones CP. Clinical outcomes and complications of midfoot Charcot reconstruction with intramedullary beaming. Foot Ankle Int. 2019;40(1):18–23.

    Article  PubMed  Google Scholar 

  6. Dhawan V, Spratt KF, Pinzur MS, Baumhauer J, Rudicel S, Saltzman CL. Reliability of AOFAS diabetic foot questionnaire in Charcot arthropathy: stability, internal con-sistency and measurable difference. Foot Ankle Int. 2005;26(9):717–31.

    Article  PubMed  Google Scholar 

  7. Kroin E, Schiff AP, Pinzur MS, Davis ES, Chaharbakhshi E, FA DS Jr. Functional impairment of patients undergoing surgical correction for Charcot foot Arthropathy. Foot Ankle Int. 2017;38(7):705–9.

    Article  PubMed  Google Scholar 

  8. Kroin E, Chaharbakhshi EO, Schiff A, Pinzur MS. Improvement in quality of life following surgical correction of midtarsal Charcot foot deformity. Foot Ankle Int. 2018;39(7):808–11.

    Article  PubMed  Google Scholar 

  9. Harkins E, Murphy M, Schneider A, Schiff A, Pinzur MS. Deformity and clinical outcomes following surgical correction of Charcot ankle. Foot Ankle Int. 2019;40(2):145–51.

    Article  Google Scholar 

  10. Fabrin J, Larsen K, Holstein PE. Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care. 2000;23:796–800.

    Article  CAS  PubMed  Google Scholar 

  11. Pinzur MS, Kernan-Schroeder D, Emmanuele NV, Emmanuele MA. Development of a nurse-provided health system strategy for diabetic foot care. Foot Ankle Int. 2001;22:744–6.

    Article  CAS  PubMed  Google Scholar 

  12. Hastings MK, Johnson JE, Strube MJ, Hildebolt CF, Bohnert KL, Pryor FW, Sinacore DR. Progression of foot deformity in Charcot neuropathic osteoarthropathy. J Bone Joint Surg. 2013;95A:1206–13.

    Article  Google Scholar 

  13. Wukich DK, Raspovic KM, Hobizal KB, Rosario B. Radiographic analysis of diabetic midfoot Charcot neuroarthropathy with and without midfoot ulceration. Foot Ankle Int. 2014;35(11):1108–15.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bevan WP, Tomlinson MP. Radiographic measure as a predictor of ulcer formation in diabetic Charcot midfoot. Foot Ankle Int. 2008;29:568–73.

    Article  PubMed  Google Scholar 

  15. Pinzur MS. Surgical vs. accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int. 2004;25:545–9; PMID: 15363375.

    Article  PubMed  Google Scholar 

  16. Connolly JF, Csencsitz TA. Limb threatening neuropathic complications from ankle fractures in patients with diabetes. Clin Orthop. 1998;348:212–9.

    Article  Google Scholar 

  17. Strotman P, Reif TJ, Pinzur MS. Current concepts: Charcot arthropathy of the foot and ankle. Foot Ankle Int. 2016;37(11):1255–63.

    Article  PubMed  Google Scholar 

  18. Bibbo C, Lin SS, Beam HA, Behrens FF. Complications of ankle fractures in diabetic patients. Orthop Clin North Am. 2001;32:113–33.

    Article  CAS  PubMed  Google Scholar 

  19. Jani MM, Ricci WM, Borrelli J Jr, Barrett SE, Johnson JE. A protocol for treatment of unstable ankle fractures using transarticular fixation in patients with diabetes mellitus and loss of protective sensibility. Foot Ankle Int. 2003;24(11):838–44.

    Article  PubMed  Google Scholar 

  20. Koval KJ, Petraco DM, Kummer FJ, Bharam S. A new technique for complex fibula fracture fixation in the elderly: a clinical and biomechanical evaluation. J Orthop Trauma. 1997;11(1):28–33.

    Article  CAS  PubMed  Google Scholar 

  21. Perry MD, Taranow WS, Manoli A II, Carr JB. Salvage of failed neuropathic ankle fractures: use of large fragment fibular plating and multiple syndesmotic screws. Foot Ankle Int. 2005;14(2):85–91.

    CAS  Google Scholar 

  22. Ganesh SP, Pietrobon R, Cecílio WA, Pan D, Lightdale N, Nunley JA. The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am. 2005;87(8):1712–8.

    PubMed  Google Scholar 

  23. Wukich DK, Kline AJ. The management of ankle fractures in patients with diabetes. J Bone Joint Surg Am. 2008;90(7):1570–8.

    Article  PubMed  Google Scholar 

  24. Johnson JE. Surgical reconstruction of the diabetic foot and ankle. Foot Ankle Clin. 1997;2:37–55.

    Google Scholar 

  25. Johnson JE. Operative treatment of neuropathic arthropathy of the foot and ankle. J Bone Joint Surg. 1998;80A(11):1700–9.

    Article  Google Scholar 

  26. Ebaugh MP, Umbel B, Goss D, Taylor BC. Outcomes of primary tibiotalocalcaneal nailing for complicated diabetic ankle fractures. Foot Ankle Int. 2019;40(12):1382–7.

    Article  PubMed  Google Scholar 

  27. Muckley T, Eichorn S, Hoffmeier C, von Oldenburg G, Speitling A, Hoffman GO, Buhren V. Biomechanical evaluation of primary stiffness of tibiotalocalcaneal fusion with intramedullary nail. Foot Ankle Int. 2007;28(2):224–31.

    Article  PubMed  Google Scholar 

  28. Santangelo JR, Glisson RR, Garras DN, Easley ME. Tibiocalcaneal arthrodesis: a biomechanical comparison of multiplanar external fixation with intramedullary fixation. Foot Ankle Int. 2009;29(9):936–41.

    Article  Google Scholar 

  29. Easley ME, Montijo HE, Wilson JB, Fitch RD, Nunley JA. Revision tibiotalar arthrodesis. J Bone Joint Surg. 2008;90(6):1212–23.

    Article  PubMed  Google Scholar 

  30. Finkler ES, Kasia C, Kroin E, Davidson-Bell V, Schiff AP, Pinzur MS. Pin tract infection following correction of Charcot foot with static circular fixation. Foot Ankle Int. 2015;36:1310–5.

    Article  PubMed  Google Scholar 

  31. El-Mowafi H, Abulsaad M, Kandil Y, El-Hawary A, Ali S. Hybrid fixation for ankle fusion in diabetic Charcot arthropathy. Foot Ankle Int. 2018;39(1):93–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA

    Michael S. Pinzur

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  1. Michael S. Pinzur
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Correspondence to Michael S. Pinzur .

Editor information

Editors and Affiliations

  1. Center for Bone and Joint Disease, Hudson, FL, USA

    Dolfi Herscovici Jr.

  2. Hughston Orthopedic Trauma, Indianapolis, IN, USA

    Jeffrey O. Anglen

  3. Texas Orthopaedic Associates, Dallas, TX, USA

    John S. Early

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Pinzur, M.S. (2023). The Neuropathic (Charcot) Ankle. In: Herscovici Jr., D., Anglen, J.O., Early, J.S. (eds) Evaluation and Surgical Management of the Ankle. Springer, Cham. https://doi.org/10.1007/978-3-031-33537-2_17

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  • DOI: https://doi.org/10.1007/978-3-031-33537-2_17

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-33536-5

  • Online ISBN: 978-3-031-33537-2

  • eBook Packages: MedicineMedicine (R0)

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