The ulcer associated with Charcots osteoarthropathy and deformity

When ulceration occurs over a bony prominence associated with a deformed Charcot's osteoarthropathy, it is notoriously difficult to heal. Ulceration is a frequent complication of rockerbottom, medial convexity and unstable hindfoot Charcot's osteoarthropathy.

Patients with bony prominences on deformed feet with Charcot's osteoarthropathy need regular removal of callus to prevent ulceration. We use the total-contact cast to treat most ofthese ulcers (Fig. 4.29a,b).

In addition, we have used advanced wound healing products including Dermagraft, Apligraf and Hyaff to promote healing of ulceration over tarsal deformities (Fig. 4.30a,b).

However, conservative measures may fail. If management in a cast does not achieve healing within 3 months, surgery should be considered. Exostectomy is indicated for the mid-foot Charcot's osteoarthropathy and internal stabilization of the ankle for the hindfoot ulcer which is not healing. The patient shown in Fig. 4.31a,b developed indolent ulceration over an unstable ankle with Charcot's osteoarthropathy of the hindfoot, but healed after he underwent internal fixation.

Fig. 4.29 (a) This foot with Charcot's osteoarthropathy and rockerbottom deformity developed an indolent plantar ulcer. When this picture was taken the ulcer had been present for 6 years, (b) The same foot healed in 12 months. The patient had remained at work throughout the casting period and was very active, working as an architect and inspecting building sites.

Fig. 4.29 (a) This foot with Charcot's osteoarthropathy and rockerbottom deformity developed an indolent plantar ulcer. When this picture was taken the ulcer had been present for 6 years, (b) The same foot healed in 12 months. The patient had remained at work throughout the casting period and was very active, working as an architect and inspecting building sites.

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