Ankle Reconstruction in Charcot's Neuroarthropathy: Challenges and Solutions

Vinod K Panchbhavi
2016 Journal of Foot and Ankle Surgery Asia Pacific  
Ankle injuries in the presence of neuropathy have potential to cause deformity in the ankle, which can in turn cause ulcerations and infections leading to significant morbidity including loss of limb or even life. These injuries although devastating can start off innocuously and may not be immediately apparent to the patient because of lack of pain. This can lead to a late presentation. Often, the main concern is swelling, for which the patient seeks attention. And even when medical attention
more » ... sought, unless the physician is vigilant, the condition can potentially be missed or misdiagnosed as deep vein thrombosis or cellulitis. A sprain or even a fracture in the ankle is not suspected as the patient retains the ability to walk. This condition and its true nature further escapes detection if, as often is the case, a nonweight-bearing radiograph is obtained. Radiographs obtained without the weight-bearing or other stress modality may not reveal the instability at the ankle joint due to ligament damage. A thorough clinical evaluation including assessment for neuropathy and weight-bearing radiographs are necessary for diagnosis. Stable fractures and ankle sprains can be managed conservatively in a cast or boot. Unstable ankle following ligamentous disruption and/or fractures in the vicinity of the ankle needs internal or external stabilization. The stabilization in the presence of neuropathy should be stronger and the protection from weight bearing last longer and twice that used for patients with similar condition but without neuropathy.
doi:10.5005/jp-journals-10040-1051 fatcat:mhcesthxlnbjzik7cupfqpgzk4