Long-Term Outcomes of a Novel Surgical Approach for Early Charcot Neuroarthropathy

Charcot neuroarthropathy (CN) of the foot is a progressive condition associated with significant deformity and recurrent ulceration. Despite advancements in imaging and classification, management remains challenging. Traditional nonsurgical treatments have shown limited success in preventing disease progression, while surgical interventions often involve prolonged nonweight-bearing periods and high complication rates.

This study presents an 8-year follow-up of 15 patients (Evidence Level IV) undergoing a novel early surgical intervention for Stage 0-1 CN with preoperative plantigrade alignment. The procedure involved fluoroscopically guided filling of subchondral defects using a flowable calcium phosphate compound and realignment with dynamic circular external fixation in 14 of 15 subjects. Assisted weight-bearing began 3-5 days postoperatively, with fixation removed after 6-8 weeks. Radiographic parameters (Meary's angle, calcaneal inclination angle, talar declination angle, and cuboid height) were assessed preoperatively and at final follow-up.

Thirteen of 15 subjects survived the 8 years. No surgical complications, ipsilateral CN, or midfoot ulcerations occurred. Radiographic alignment remained stable over 8 years (p < 0.01 for all parameters).

Early surgical intervention with subchondral defect filling and external fixation appears to stabilize osseous architecture, prevent midfoot collapse, and expedite recovery in CN. Larger prospective studies are warranted to validate these findings.