Minimally Invasive Surgical Correction of Hindfoot and Ankle Deformities in Charcot Neuroarthropathy: A Proof-of-Concept in Five Patients.

Abstract

Background: Charcot neuroarthropathy (CN) of the hindfoot or ankle often results in important deformity, instability, chronical ulceration and infection that, without adequate treatment, could lead to trans-tibial amputation. Several surgical procedures for the reconstruction of hindfoot- and ankle CN deformities have been described in literature. Their main disadvantage is the extensive soft tissue dissection, which could lead to infection, necrosis and implant failure.

Methods: We introduce a novel technique of minimally invasive surgery (MIS) for correction of CN deformities, followed by retrograde intramedullary nailing of the hindfoot for stabilization. This retrospective limited case-series reports the outcome of 5 patients (3 women, 2 men, 5 feet) with unstable hindfoot Charcot deformities and neuropathic ulcers who underwent MIS.

Results: Mean age was 54.5 years ; the median American Society of Anesthesiologists score was 3. Three patients underwent a single-stage procedure and two patients underwent a two-stage treatment. No postoperative infections occurred. Healing of ulcerations was achieved at average of 5 weeks. Hindfoot angle improved from 33.6 to 6.2 degrees (p<.05). At a mean follow-up of 20.6 months, limb preservation was achieved for all patients. There was no failure of correction or fixation. The mean American Orthopedic Foot & Ankle Society (AOFAS) score improved from 45.0 to 79.8 (p<.05). The mean Euroqol EQ-5D-5L score improved from 0.23 to 0.82 (p<.05).

Conclusion: This proof-of-concept shows that MIS of CN hindfoot and ankle deformities can be a safe and efficient procedure, providing short-term healing of neuropathic ulcers and long-term improvement of function and quality of life.