Orthopaedic surgery and the diabetic Charcot foot

Over the past two decades, a gradual trend toward more aggressive management of diabetic Charcot neuroarthropathy has occurred, mainly due to improved understanding of the pathophysiology and advances in surgical techniques. Although the mainstay of diabetic Charcot foot management is still nonoperative, surgical reconstruction using internal and external fixation techniques is indicated in patients with progressive deformity, instability, recurrent ulceration, and impending compromise of the soft tissue envelope. The ultimate goal of treatment, whether nonsurgical or surgical, is to achieve a stable, plantigrade foot that can be accommodated with appropriate shoe wear and orthotics. Various surgical procedures are described.