Treatment of bone destructiondeformity

The aim of treatment is immobilization in a plaster cast (see Chapter 4) until there is no longer evidence on X-ray of continuing bone destruction, and the foot temperature is within 2°C of the contralateral foot, which can be measured with an infrared thermometer. When this is achieved, the foot has reached the stabilization phase.

Deformity in a Charcot's osteoarthropathy can predispose to ulceration, particularly on the plantar surface of the rockerbottom deformity. It may also occur on the medial convexity. These ulcers may become infected and

Fig. 3.22 Rockerbottom deformity of the mid-foot with early breakdown.

lead to osteomyelitis. This may be difficult to distinguish from neuropathic bone and joint changes, as on X-ray, bone scan or magnetic resonance imaging, appearance is similar.

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