A Surgical Decision-Making Algorithm for Reconstruction of Charcot Neuroarthropathy

Surgical reconstruction of the foot and ankle following degenerative changes secondary to Charcot neuroarthropathy poses a challenge due to both soft-tissue and osseous deformity. As a limb salvage procedure, this article aims to address such deformity with the goal of returning to a braceable limb without subsequent ulceration and infection. As this disease process affects both bone and soft tissue, surgical reconstruction should be directed to address osseous and ligamentous deformities that may contribute to postoperative failure. We present an algorithm to eliminate deforming forces, identify and stabilize at-risk and damaged anatomy, and stabilize the ankle joint to reduce the risk of postoperative progression to Charcot collapse of the ankle joint in individuals with midfoot Charcot neuroarthropathy. In conjunction with a multidisciplinary infection, perfusion, and bone metabolism assessment, this algorithm serves as comprehensive tool to evaluate and reconstruct midfoot Charcot collapse.