Superconstructs in the Treatment of Charcot Foot Deformity: Plantar Plating, Locked Plating, and Axial Screw Fixation

Classification

Multiple classification systems have been proposed to describe the deformities associated with neuroarthropathy of the foot and ankle. Brodsky and Rouse⁶ classified neuroarthropathy based on location: disease in the midfoot (type 1), the hindfoot (type 2), the ankle (type 3a), and avulsion fracture of the calcaneus by the Achilles tendon (type 3b). Disease in multiple locations was classified as type 4, and disease in the forefoot was classified as type 5.

In 1998, Sammarco and Conti,²⁰ and

Preoperative management

Preoperative assessment is of critical importance in achieving a successful clinical result. A thorough work-up for infection is necessary in many cases because the presence of osteomyelitis drastically changes the recommended treatment protocol. Many Charcot patients present with Eichenolz stage I disease, and this can be difficult to differentiate from cellulitis and osteomyelitis. The scenario is often complicated because the patient may be seen after admission by the internal medicine

“Superconstructs”

Neuropathic midfoot disease is inherently difficult to treat surgically. “Dissolution” of the bone in the area of fracture with resultant dislocation is one of the hallmarks of the disease process and is thought to be caused by sympathetic denervation and a resultant hyperemia. Bony dissolution, fragmentation, and osteoporosis increase the technical demands of midfoot reconstruction in neuropathic fractures. Earlier series reported recurrence of the deformity and nonunion as common sequelae of

Summary

Management of Charcot deformity of the foot and ankle continues to challenge physicians. Medical comorbidity, peripheral neuropathy, vascular disease, and immune impairment cause severe problems for these patients and, when combined with neuroarthropathy, can lead to amputation. Progressive bony deformity and bone resorption, which may accompany neuroarthropathy, only increase the challenge of surgical treatment. These challenges have led physicians to develop superconstruct techniques whereby