Surgery for Charcot Foot

Orthopedic surgeons at NYU Langone’s Diabetic Foot and Ankle Center may recommend surgery for people with Charcot foot if they have severe fractures and dislocations that do not respond to nonsurgical treatment.

These injuries cause the bones of the foot to become misaligned, which can affect the way weight is distributed across the foot during movement. Without intervention, the bones and joints may collapse.

In addition, continuing to put weight on a foot with these injuries increases the risk of ulcers, which can lead to serious infection.

The goals of surgery for Charcot foot are to stabilize any fractured bones or dislocated joints and allow them to heal. A surgeon may also realign or fuse the bones of the foot to better position them to bear weight.

After the foot has healed, our surgeons recommend using orthotic shoe inserts, braces, or a customized boot to help maintain an even distribution of weight across the bones of the foot. Long-term use can help you avoid further damage to the bones and joints, as well as prevent the formation of ulcers.

Exostectomy

Over time, Charcot foot can lead to changes in the bone structure of the foot. Bones may move out of place as the result of multiple fractures and dislocations.

To compensate, the body creates new bone material in the form of bony bumps called prominences. These usually form on the bottom of the foot and can lead to changes in the way body weight is distributed across the foot during movement. When weight is concentrated on one area of the foot, the increased pressure may lead to additional fractures or the development of ulcers.

If the bones of the foot are stable—meaning there is no unusual movement between bones, and the foot is capable of bearing weight—your NYU Langone doctor may recommend an exostectomy to remove the bony prominence. This procedure is performed using regional or general anesthesia.

In an exostectomy, the surgeon shaves or removes the bony prominences. The surgery restores even weight distribution and reduces the risk of further damage.

After surgery, most people return home on the same day. Your doctor may provide you with crutches or a walker to help you keep weight off of the affected foot.

Achilles Tendon Lengthening

The Achilles tendon is a strong, fibrous tissue that runs along the back of the leg and the heel. In people with Charcot foot, the tendon may become too tight, causing the weight of the body to shift to the front part of the foot during movement.

This increased pressure elevates the risk of ulcers on the bottom of the foot. If you have an ulcer, continuing to walk on it without correcting your gait can keep it from healing.

In an Achilles tendon lengthening procedure, a surgeon releases the tension from the Achilles tendon, alleviating stress on the bones of the foot. This restores a better alignment and takes excess pressure off of an ulcer, allowing it to heal.

This procedure takes place in the hospital and requires general anesthesia. An orthopedic surgeon makes small incisions in the back of the foot to reach the Achilles tendon. He or she then gently stretches and cuts the tendon, lengthening it.

Immediately after the surgery, your doctor applies a cast or a removable, supportive boot to cover your foot and lower leg. It’s worn for two to six weeks. After it is removed, your doctor may recommend that you wear a leg brace for several weeks.

Fusion

If damage to joints in the foot or ankle leads to chronic instability, in which the bones move around when weight is put on the foot, your doctor may recommend a fusion of two or more bones in the foot to stabilize the joint and prevent further damage.

In this procedure, surgeons bind together the bones of the damaged joint using small metal screws and, occasionally, metal plates. Over time, these bones grow together, resulting in one fused bone and eliminating painful movement between bones.

Fusion is performed using local anesthesia with sedation or general anesthesia. Most people can go home on the same day as surgery.

After the surgery, you need crutches to help you walk without putting weight on the fused bones. In addition to crutches, you should wear a protective splint for 10 to 14 days. At that time, doctors examine your foot, and, if you are healing well, provide you with a removable, supportive boot.

Crutches are usually necessary for another 4 to 10 weeks, depending on the extent of the procedure. The boot should be worn for three months or longer to support the foot while it heals.

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