Power of the 3rd Opinion: The Charcot Foot

I recently finished a 6 month limb salvage project on a 42yo diabetic male who was referred to me for reconstruction and salvage of his left foot. He initially injured his foot 2 years ago with a simple midfoot sprain. It was mismanaged and he sustained a Charcot event of his midfoot. He underwent surgical stabilization which ultimately ended up failing. His foot continued to collapse, and he was no longer able to walk and in uncontrollable pain. He was referred to another surgeon for further management given his rapidly deteriorating condition. He underwent another attempt at salvage with a midfoot fusion of the prior area that failed. After 4 months of grueling recovery, the 2nd surgery had also failed. His surgeon at that time recommended below knee amputation. Given the failure of 2 prior surgeries and ongoing collapse, it was deemed that the foot was no longer salvageable. 

He was mentally, physically, and emotionally crushed. After nearly 2 years of trying to get his foot fixed, he was now faced with losing his leg. He called his father for advice. His father just so happened to be a patient of mine. Receiving an ankle replacement about 2.5 years prior, restoring function of his ankle along with his active lifestyle. Needless to say, father and son ended up in my office looking for a miracle. 

After an extensive medical work up and optimization process, we embarked on a 3rd attempt for fusion and stabilization of his foot. Sticking to sound recontructive principles we performed a hindfoot/midfoot fusion with extensive grafting and tendon balancing. 

Six months post procedure the patient just returned from a trip with his father back to their hometown. Seeing old family and friends, he was able to ambulate in his protective boot. Life and function was restored and his leg saved. 

At every appointment, he thanks me for changing his life, but as I tell him and all my Charcot patients we are a team. He changed his lifestyle and made modifications that improved his health, and I was able to use my bio mechanical knowledge to fix his foot. It also helps that the stars aligned and I had a successful surgical history with his dad. 

If you have been told below knee amputation is the only solution, I encourage you to seek out another opinion even if you have had more than one. In this case, it was the power of the 3rd opinion that changed this patient’s outcome. 

Author

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