Surgical reconstruction of Charcots osteoarthropathy of the hindfoot

A 61 -year-old lady with type 1 diabetes of 40 years' duration developed a hot, red, swollen foot and ankle, and Charcot's osteoarthropathy was diagnosed. She was unwilling to wear a total-contact cast, but agreed to wear an Aircast. One month later she attended a wedding and discarded the Aircast for 1 day. She returned to the foot clinic the following week with an unstable flail ankle. She underwent surgical reconstruction (Fig. 3.26) and returned to the foot clinic in a non-weightbearing plaster cast which she wore for 4 months, using a knee scooter to off-load the foot. A CROW was made and she began to remobilize. She developed a swelling on the front of her ankle where a screw from her internal fixation metal plate had worked loose, and the screw was surgically removed. The joint remained stable and an AFO was made for her long-term management with bespoke footwear and insoles. She did not relapse and remained ulcer free.

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