Charcot Neuroarthropathy: What is It and How do we Fix It?

Charcot Reconstruction Options

 

One of my passions as a foot and ankle surgeon is limb salvage. Charcot neuroarthropathy is the most challenging threat to limbs that I encounter on a routine basis. These patients are not only challenging from a reconstructive perspective, but also come with multiple medical challenges (neuropathy, diabetes, kidney disease, decreased bone density). Even though the limb is threatened, the medical challenges of the patient also make salvage a larger endeavor. 

 

I follow an algorithm designed, tested, and implemented by my mentor discussed in detail here. The core principles of this algorithm have allowed me to save legs and alter lives that otherwise would be lost. Despite these efforts, sometimes I still lose. Every leg lost is a lesson learned, providing guidance to help the next patient needing salvage.

 

I firmly believe that every patient with Charcot deserves a chance at salvage. Around the world, and even locally, the recommendation is below knee amputation. The mindset is to cut your losses, and move on with your life. Statistically, this is not a wise decision for most patients with Charcot because they never walk with a prosthesis due to a multitude of reasons. Salvage is their best chance to maintain a level of function necessary to live a somewhat normal life. 

 

Depending on the severity of the deformity, bone collapse and loss, ulceration, and level of infection, multiple surgeries may be required to stabilize the limb. Oftentimes, it can take months to years to completely stabilize limb or functional ambulation.  This process can be significantly long for the patient and can be exhaustive on many levels including mentally, physically, and financially due to prolonged recovery times. In the end, though, when the patient and I have won and the limb is saved at no point does the patient say this was more hassle than it was worth. Together we put in the hard work and the patient is where they want to be. If you are suffering from Charcot and you are interested in limb salvage, please call to schedule an appointment today. It would be my pleasure to try and help you.



Author
Dr. Zachary Flynn DPM, FACFAS Fellowship Trained Foot & Ankle Surgeon

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