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The Journal of Bone and Joint Surgery 80:1700-9 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Operative Treatment of Neuropathic Arthropathy of the Foot and Ankle*{dagger}

JEFFREY E. JOHNSON, M.D.{dagger}, ST. LOUIS, MISSOURI

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons


   Introduction
 
Nonoperative treatment with use of a total-contact cast followed by appropriate bracing and footwear is the so-called gold standard for the treatment of most neuropathic (Charcot) fractures and dislocations of the foot and ankle. However, operative treatment is indicated for chronic recurrent ulceration, joint instability, or, in some instances, pain that has not responded to nonoperative treatment. Acute fractures may also be treated operatively if the patient is seen before demineralization of bone and inflammation of soft tissue have occurred. The goals of operative treatment are to preserve function with the aid of appropriate footwear or bracing and to avoid the need for amputation. These goals are achieved through restoration of the contour or alignment of the affected segment of the foot and ankle. Despite the potential for major operative complications, successful limb salvage and reconstruction was achieved in 124 (87 percent) of 143 patients in eight clinical series1,3,8,13,19,22,26,27.


   Natural History and Clinical Presentation
 
. . . [Full Text of this Article]


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