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Current surgical interventions of Charcot neuroarthropathy of the foot and ankle: a systematic review

  • I Wayan Subawa ,
  • I Gusti Ngurah Bagus Andhika Pramana ,
  • Adiet Wahyu Kristian ,
  • Putu Bihan Surya Kinanta ,


Introduction: Charcot neuroarthropathy (CN), also known as Charcot's foot, is consequently causing a reduction in quality of life, high disability, and an increased risk of mortality that poses many clinical challenges in its diagnosis and management. Common surgical interventions typically include ulcer debridement, exostectomy, deformity correction, and minor and major amputations.

Methods: This systematic review was conducted using the PRISMA guideline. Literature research incorporating PubMed/ MEDLINE database for English language studies published in the last 5 years with the key terms defined using the PICO framework, which includes: Charcot, neuroarthropathy/arthropathy, neurogenic, and surgery, which were used interchangeably. A further set of keywords within the topic were then identified, including ankle, hindfoot, foot, fore-foot, and mid-foot.

Result: 221 feet undergone surgical reconstruction. Bony fusion occurred in 154 of 221 feet (71%), 79 of 128 feet (62%) in internal fixation, 47 of 58 feet (81%) in external fixation, and 29 of 34 feet (85%) in the utilization of both internal and external fixation.

Conclusion: Charcot neuroarthropathy poses many clinical challenges in its diagnosis and management. Many experts have proposed the implementation of different strategies to manage this complex condition depending on the acute and chronic phases of its nature. Delayed diagnosis can result in a severe deformity that can act as a gateway to ulceration, and infection and, in the worst case, can lead to limb loss. Further studies aimed at determining selection criteria and treatment algorithms are required for greater standardization of outcomes.


  1. Armstrong DG, Peters EJ. Charcot's arthropathy of the foot. J Am Podiatr Med Assoc. 2002;92(7): 390–4.
  2. Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45(8):1085-1096. doi:10.1007/s00125-002-0885-7.
  3. Sanders LJ. The Charcot foot. In: Bowker JH, Pfeifer MA (eds.) Levin and O'Neal's The Diabetic Foot. 7th ed. Mosby; 2002, 257–83.
  4. Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Diabetes Care. 2011;34(9):2123-2129. doi:10.2337/dc11-0844.
  5. Frykberg RG, Belczyk R. Epidemiology of the Charcot foot. Clin Podiatr Med Surg. 2008;25(1):17-v. doi:10.1016/j.cpm.2007.10.001.
  6. Pakarinen TK, Laine HJ, Mäenpää H, Mattila P, Lahtela J. Long-term outcome and quality of life in patients with Charcot foot. Foot Ankle Surg. 2009;15(4):187-191. doi:10.1016/j.fas.2009.02.005.
  7. Hoché G, Sanders LJ. On some arthropathies apparently related to a lesion of the brain or spinal cord, by Dr J.-M. Charcot. January 1868. J Am Podiatr Med Assoc. 1992;82(8):403-411. doi:10.7547/87507315-82-8-403.
  8. Jordan WR. Neuritic manifestation in diabetes mellitus. Arch Intern Med. 1936;57: 307–66. doi:10.1001/archinte.1936.00170060069004.
  9. Sequeira W. The neuropathic joint. Clin Exp Rheumatol. 1994;12(3): 325–37
  10. Wukich DK, Sung W. Charcot arthropathy of the foot and ankle: modern concepts and management review. J Diabetes Complications. 2009;23(6):409-426. doi:10.1016/j.jdiacomp.2008.09.004.
  11. Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJ. Diabetic foot syndrome: evaluating the prevalence and incidence of foot pathology in Mexican Americans and non-Hispanic whites from a diabetes disease management cohort. Diabetes Care. 2003;26(5):1435-1438. doi:10.2337/diacare.26.5.1435.
  12. Sohn MW, Stuck RM, Pinzur M, Lee TA, Budiman-Mak E. Lower-extremity amputation risk after charcot arthropathy and diabetic foot ulcer. Diabetes Care. 2010;33(1):98-100. doi:10.2337/dc09-1497.
  13. Botek G, Figas S, Narra S. Charcot Neuroarthropathy Advances: Understanding Pathogenesis and Medical and Surgical Management. Clin Podiatr Med Surg. 2019;36(4):663-684. doi:10.1016/j.cpm.2019.07.002.
  14. Lowery NJ, Woods JB, Armstrong DG, Wukich DK. Surgical Management of Charcot Neuroarthropathy of the Foot and Ankle: A Systematic Review. Foot & Ankle International. 2012;33(2):113-121. doi:10.3113/FAI.2012.0113.
  15. Schneekloth BJ, Lowery NJ, Wukich DK. Charcot Neuroarthropathy in Patients With Diabetes: An Updated Systematic Review of Surgical Management. J Foot Ankle Surg. 2016;55(3):586-590. doi:10.1053/j.jfas.2015.12.001.
  16. Richter M, Mittlmeier T, Rammelt S, Agren PH, Hahn S, Eschler A. Intramedullary fixation in severe Charcot osteo-neuroarthropathy with foot deformity results in adequate correction without loss of correction - Results from a multicentre study [published correction appears in Foot Ankle Surg. 2016 Dec;22(4):289]. Foot Ankle Surg. 2015;21(4):269-276. doi:10.1016/j.fas.2015.02.003.
  17. Hegewald KW, Wilder ML, Chappell TM, Hutchinson BL. Combined Internal and External Fixation for Diabetic Charcot Reconstruction: A Retrospective Case Series. J Foot Ankle Surg. 2016;55(3):619-627. doi:10.1053/j.jfas.2015.04.016.
  18. Matsumoto T, Parekh SG. Midtarsal reconstructive arthrodesis using a multiaxial correction fixator in charcot midfoot arthropathy. Foot Ankle Spec. 2015;8:472e478.
  19. Ettinger S, Plaass C, Claassen L, Stukenborg-Colsman C, Yao D, Daniilidis K. Surgical Management of Charcot Deformity for the Foot and Ankle-Radiologic Outcome After Internal/External Fixation. J Foot Ankle Surg. 2016;55(3):522-528. doi:10.1053/j.jfas.2015.12.008.
  20. Harkin EA, Schneider AM, Murphy M, Schiff AP, Pinzur MS. Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle. Foot Ankle Int. 2019;40(2):145-151. doi:10.1177/1071100718805076.
  21. Ford SE, Cohen BE, Davis WH, Jones CP. Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming. Foot Ankle Int. 2019;40(1):18-23. doi:10.1177/1071100718799966.
  22. Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res. 2015;473(3):1168-1171. doi:10.1007/s11999-014-4059-y.
  23. Trieb K. The Charcot foot: pathophysiology, diagnosis and classification. Bone Joint J. 2016;98-B(9):1155-1159. doi:10.1302/0301-620X.98B9.37038.
  24. Sammarco VJ. Superconstructs in the treatment of charcot foot deformity: plantar plating, locked plating, and axial screw fixation. Foot Ankle Clin. 2009;14(3):393-407. doi:10.1016/j.fcl.2009.04.004.
  25. Garchar D, DiDomenico LA, Klaue K. Reconstruction of Lisfranc joint dislocations secondary to Charcot neuroarthropathy using a plantar plate. J Foot Ankle Surg. 2013;52(3):295-297. doi:10.1053/j.jfas.2013.02.019.
  26. Farber DC, Juliano PJ, Cavanagh PR, Ulbrecht J, Caputo G. Single stage correction with external fixation of the ulcerated foot in individuals with Charcot neuroarthropathy. Foot Ankle Int. 2002;23(2):130-134. doi:10.1177/107110070202300209.
  27. Pinzur MS. Neutral ring fixation for high-risk nonplantigrade Charcot midfoot deformity. Foot Ankle Int. 2007;28(9):961-966. doi:10.3113/FAI.2007.0961.
  28. Wukich DK, Raspovic KM, Hobizal KB, Rosario B. Radiographic analysis of diabetic midfoot charcot neuroarthropathy with and without midfoot ulceration. Foot Ankle Int. 2014;35(11):1108-1115. doi:10.1177/1071100714547218.
  29. Siddiqui NA, LaPorta GA. Midfoot Charcot Reconstruction. Clin Podiatr Med Surg. 2018;35(4):509-520. doi:10.1016/j.cpm.2018.07.003.
  30. Burns PR, Wukich DK. Surgical reconstruction of the Charcot rearfoot and ankle. Clin Podiatr Med Surg. 2008;25(1):95-viii. doi:10.1016/j.cpm.2007.10.008.
  31. Simon SR, Tejwani SG, Wilson DL, Santner TJ, Denniston NL. Arthrodesis as an early alternative to non-operative management of charcot arthropathy of the diabetic foot. J Bone Joint Surg Am. 2000;82-A(7):939-950. doi:10.2106/00004623-200007000-00005.

How to Cite

I Wayan Subawa, I Gusti Ngurah Bagus Andhika Pramana, Adiet Wahyu Kristian, & Putu Bihan Surya Kinanta. (2022). Current surgical interventions of Charcot neuroarthropathy of the foot and ankle: a systematic review. Bali Medical Journal, 11(2), 722–728.




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I Gusti Ngurah Bagus Andhika Pramana
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Adiet Wahyu Kristian
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Putu Bihan Surya Kinanta
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