Management of Charcot Neuroarthropathy of Foot with Hindfoot Retrograde Intramedullary Nail

Background: Charcot neuroarthropathy (CN) in the foot involves a gradual deterioration of the joints, and it can lead to serious consequences. It often requires surgical intervention for the management of Charcot neuroarthropathy in the foot and ankle. However, surgical approaches are associated with a significant risk of complications. Despite positive outcomes reported with tibiotalocalcaneal arthrodesis (TTCA) in patients with CN, the selection of the appropriate implant remains a concern. The authors present their findings from implementing a specific surgical method—tibiotalocalcaneal arthrodesis using a hindfoot retrograde intramedullary nail for treating Charcot neuroarthropathy of the foot.

Materials and Methods: Forty-one patients with Charcot neuroarthropathy who were treated with tibiotalocalcaneal arthrodesis using hindfoot retrograde intramedullary nail were prospectively studied, in a tertiary care centre in south India. All the patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) score, one year after surgery.

Results: The average age of participants was 67.4 years (±8.7), with 63.5% being female. The most prevalent cause was diabetes mellitus (75.6%), followed by post-traumatic CN (19.5%) and chronic alcoholism (4.9%). At the end of one year, eleven individuals (26.8%) achieved a good score, up from five (12.2%) preoperatively, and twenty individuals (48.8%) had a fair score compared to fifteen (36.6%). The AOFAS score showed improvement one year following surgery (p value 0.001). In twenty patients (48.8%), the time required for union exceeded 6 months; meanwhile, 15 patients (36.6%) achieved union within 6 months post-surgery. Six patients (14.6%) experienced non-union. Among them, two patients (4.9%) faced deep infection alongside non-union. Hardware failure occurred in 3 patients (7.3%). One patient (2.4%) had both hardware failure and non-union. Four patients (9.8%) developed superficial wound infections, and one patient (2.4%) underwent amputation.

Conclusion: Tibiotalocalcaneal arthrodesis using a retrograde hind foot intramedullary nail is a safe and effective treatment option that yields positive clinical results and manageable complication rates for individuals with Charcot neuroarthropathy of the foot. Most patients have successfully attained independent mobility and experienced enhancements in their quality of life. This procedure often eliminates the necessity for below-knee amputation in most cases