Calcaneotalotibial arthrodesis by retrograde intramedullary nailing for Charcot osteo-neuroarthropathy of the foot and ankle

Background
The Charcot’s foot and ankle presents a significant and complex clinical challenge for foot and ankle surgeons. Neuropathic arthropathy of the foot and ankle is a degenerative deformity that gradually worsens over time. It is most frequently observed in individuals with diabetic neuropathy.


Aim and objectives
To evaluate the efficacy, advantages, and disadvantages of calcaneotalotibial arthrodesis by retrograde intramedullary nailing for Charcot osteo-neuroarthropathy of the ankle.


Patients and methods
This prospective research was done on 20 cases with Charcot osteoarthropathy of the ankle using calcaneotalotibial interlocking nails at Helwan University Hospital, Al Helal Hospital, Boulak El Dakror General Hospital, and Kasr Al Ainy Hospital during the period between January 2021 and January 2022.


Results
Patients had both types of diabetes mellitus. As regard complications, they occurred in seven (35%) patients as follows: one patient had an intraoperative distal tibial crack during nail introduction, two patients had loosening of proximal screws and infection, three patients had skin infection at the site of distal screws, and one patient had deep infection improved with parenteral antibiotics. There was a statistically significant improvement in the American Orthopedic Foot and Ankle Society score among the studied patients with a P value less than 0.001.


Conclusion
We observed a satisfactory result in the treatment of severe abnormalities of the ankle and hind foot in Charcot neuroarthropathy utilizing the retrograde intramedullary arthrodesis nail. The transcalcaneal retrograde intramedullary represents a safe and efficacious fixation option.