Ulceration of Charcots osteoarthropathy of the midfoot

A 54-year-old man with type 2 diabetes mellitus of 12 years' duration and a mid-foot Charcot's osteoarthro pathy, developed an ulcer over the bony prominence on the plantar surface of his rockerbottom deformity which remained unhealed for 7 years. He was referred to the diabetic foot clinic and was treated with a total-contact cast and Dermagraft. The foot healed in 7 months and has remained healed (Fig. 4.32a,b).

Stretching Feet After Being Cast

Fig. 4.30 (a) Indolent ulcer under a rockerbottom deformity associated with Charcot's osteoarthropathy of the mid-foot which had been present over 6 years, (b) The same ulcer healed in 30 months after being initially treated with Dermagraft.

Charcot Osteoarthropathy
Fig. 4.31 (a) Indolent ulceration over the lateral malleolus in an unstable ankle with Charcot's osteoarthropathy of the hindfoot. (b) The ulcer has healed following internal fixation to stabilize the ankle. The healed surgical wound can be seen.

Key points

• Patients who develop callus over a rockerbottom deformity need regular podiatry to debride callus

• Ulcers associated with deformity of Charcot's osteoarthropathy should be treated with a total-contact cast

• Advanced wound products may be helpful in conjunction with a cast

• Surgical removal of the bony prominence is a simple procedure which can achieve healing.

Fig. 4.32 (a) An ulcer over a bony prominence on a rockerbottom foot with Charcot's osteoarthropathy of the mid-foot, (b) The foot healed after 6 months with Dermagraft and off-loading.

Osteoarthropathy Diabteic Foot

Fig. 4.32 (a) An ulcer over a bony prominence on a rockerbottom foot with Charcot's osteoarthropathy of the mid-foot, (b) The foot healed after 6 months with Dermagraft and off-loading.

Drawing Pin Feet

Fig. 4.33 This patient arrived at the foot clinic with a drawing pin still in her foot. The puncture wound can be clearly seen.

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