Diabetes is a common problem. It leads to a loss in sensation to the feet which leads to ulceration and destruction of the joint in the feet called Charcot Arthropathy.
This condition leads to a progressively painless, deformed, hypermobile and unstable foot. As our feet are the post on which we stand on, these characteristics causes loss of the normal mechanics of the feet. This will lead to high contact pressures on areas in which are not used to pressure. Repeated trauma to these areas may subsequently lead to ulceration, infection and eventually osteomyelitis (infection in the bone).
The diagnosis of Charcot arthropathy is made by a combination of clinical impression, radiological investigations (plain xrays and bone scan) and a positive finding of bone shards in the joint synovium (joint lining).
Radiographs of an ankle that is affected by Charcot Arthropathy depends on the chronicity of the problem. Deformity and loss of normal alignment is the first that strikes one's mind. Complete destruction of the ankle joint and the surrounding joints such as the subtalar joint and midtarsal joints maybe evident.
The treatment of Charcot Arthropathy of the ankle is fraught with complications. Most of the modes of treatment is salvage by amputation. Various other methods of limb preservation surgery has been performed such as with external fixators and casting.
Problems associated with surgical intervention is the inability of the bone to unite and infection.
One mode of treatment which is performed at KLFAC for selected patients with this condition is called tibiotalocalcaneal fusion. This is performed by inserting a metal rod through the heel into the tibia in a retrograde fashion. This realigns the ankle and subtalar joint and provides a stable post which one can walk on.
There is lost of motion at the ankle and subtalar joint after the procedure as these joints are fused. This is an alternative treatment to amputation.