Loyola University Health System, Orthopaedic Surgery, 2160 South First Avenue, Maywood, IL 60153, USA.
Foot Ankle Int. 2012 Aug;33(8):644-6. doi: 10.3113/FAI.2012.0644.
The treatment of Charcot foot arthropathy has traditionally involved immobilization during the acute phase followed by longitudinal management with accommodative bracing. In response to the perceived poor outcomes associated with nonoperative accommodative treatment, many experts now advise surgical correction of the deformity, especially when the affected foot is not clinically plantigrade. The significant rate of surgical and medical-associated morbidity accompanying this form of treatment has led surgeons to look for improved methods of surgical stabilization, including the use of the circular ring external fixation.
Over a 7-year period, a single surgeon performed surgical correction of non-plantigrade Charcot foot deformity on 171 feet in 164 patients with a statically applied circular external fixator. Following successful correction, five patients developed a neuropathic deformity of the ipsilateral ankle after removal of the external fixator and subsequent weight bearing total contact cast.
Three of the five patients progressed to successful healing of the neuropathic (Charcot) ankle arthropathy following treatment with a series of weightbearing total contact casts. Two underwent successful ankle fusion with retrograde locked intramedullary nailing.
This unusual clinical scenario likely represents either a progression of the disease process in the foot or a complication associated with surgical correction of the original neuropathic foot deformity. A better understanding of this observation will likely become apparent as we acquire more experience with this disorder.
夏科氏关节病的治疗传统上包括在急性期进行固定，然后进行适应支撑的纵向管理。由于非手术适应治疗相关的不良结局，许多专家现在建议对畸形进行手术矫正，特别是当受累足临床不是跖行足时。这种治疗方式伴随的高手术和医疗相关发病率促使外科医生寻找改良的手术稳定方法，包括使用环形外固定架。
在 7 年期间，一位外科医生使用静态应用的环形外固定架对 164 名患者的 171 只非跖行足夏科氏足部畸形进行了手术矫正。成功矫正后，在移除外固定架并随后负重全接触石膏后，有 5 名患者出现了同侧踝关节的神经性（夏科氏）关节炎畸形。
5 名患者中有 3 名在接受一系列负重全接触石膏治疗后，神经性（夏科氏）踝关节关节炎畸形成功愈合。2 例行逆行锁定髓内钉成功踝关节融合。
这种不常见的临床情况可能代表足部疾病进程的进展，或者与原始神经性足部畸形的手术矫正相关的并发症。随着我们获得更多关于这种疾病的经验，对这种观察的更好理解可能会变得明显。
