Hindfoot Charcot's osteoarthropathy may be difficult to stabilize. An attempt may be made with total-contact casting. The cast is used during the phases of acute onset and bony destruction, to reduce oedema and halt progressive bony changes and deformity. When these phases are over, in cases where the ankle has become unstable, or deformity of the hindfoot is difficult to accommodate in boots or shoes, a Charcot restraint orthotic walker (CROW) is useful, followed by an ankle-foot orthosis (AFO) with bespoke footwear.


This is a bespoke bivalved total-contact device which externally fixates the ankle (Fig. 3.23a,b). Extra internal padding has been added to cushion the vulnerable medial malleolar area. The yellow corrugations contain ethyl vinyl acetate (EVA) to strengthen the device without increasing the bulk. All internal metal rivets have extra padding. The rigid, durable outer shell is constructed out of polypropylene and is lined with EVA. There is a bespoke moulded insole to accommodate any existing deformity and to redistribute plantar pressures. A

rockerbottom, crepe sole is attached to facilitate roll-off during walking. It is used after swelling is controlled and progressive destruction halted by total-contact casting.

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