Coronal Hindfoot Alignment in Midfoot Charcot Neuroarthropathy.

Area of Science:

• Orthopedics
• Podiatry
• Radiology

Background:

• Coronal plane hindfoot malalignment can lead to abnormal compensatory forces in the midfoot and forefoot.
• Charcot neuroarthropathy is a progressive condition affecting the foot and ankle in neuropathic patients.

Purpose of the Study:

• To compare radiographic hindfoot alignment in patients with midfoot Charcot neuroarthropathy.
• To identify specific hindfoot alignment patterns associated with Charcot joint breakdown.

Main Methods:

• Retrospective review of 43 patients (48 limbs) with midfoot Charcot neuroarthropathy.
• Classification of coronal hindfoot alignment (neutral, valgus, varus) using Saltzman hindfoot alignment radiographs.
• Classification of Charcot joint breakdown patterns (isolated tarsometatarsal, combined tarsometatarsal/naviculocuneiform, midtarsal joints).

Main Results:

• Patients with varus hindfoot alignment had a 5.8 times greater risk of breakdown at the tarsometatarsal and naviculocuneiform joints (p < .01).
• Patients with valgus hindfoot alignment had a 27 times greater risk of breakdown at the midtarsal joint (p < .01).
• Hindfoot varus is linked to external talar rotation and subsequent tarsometatarsal/naviculocuneiform joint collapse, while hindfoot valgus is linked to internal talonavicular rotation and midtarsal joint breakdown.

Conclusions:

• Varus and valgus hindfoot alignments are associated with distinct midfoot injury patterns in Charcot neuroarthropathy.
• These findings have implications for surgical management strategies.
• Focused surveillance may benefit neuropathic patients with early-stage Charcot neuroarthropathy presenting with specific hindfoot malalignments.