• Charcot's osteoarthropathy can develop after a first ray amputation or other surgical procedure
• Casting should not be undertaken if patients cannot return to the casting clinic quickly when problems arise
• Unstable hindfoot Charcot's osteoarthropathy can be stabilized, in some cases, by conservative means using a CROW, and maintained long term in an AFO and bespoke footwear.
If conservative care is unsuccessful, and the patient has a 'flail ankle', which is often associated with intractable ulceration over the malleoli, then internal stabilization may be necessary, and this is discussed in Chapter 8.
Following reconstructive ankle surgery, the lower limb is usually managed in a cast for several months and then a CROW is supplied to maintain the stability of the hindfoot. When all is stabilized, temperatures have stayed down and patient is fully ambulant, an AFO provides long-term stability.
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