Salvage Of Chronically Resistant Bilateral Charcot Foot Osteoarthropathy With Signs Of Osteomyelitis

Charcot foot osteoarthropathy is a rare, degenerative, and painless condition involving disease around joints caused by diabetes. The patient presented with ulcerations, inflammation, and redness bilaterally. Chronic diabetic ulcers related to Charcot deformity are a high risk to develop osteomyelitis and are 12x more likely to result in amputation. However, this patient was able to avoid amputation by undergoing midfoot exostectomy and adopting novel therapeutic modalities.

Methods or Case Description:

A 73-year-old female with a history of Type II diabetes, hemoglobin A1c =5.6%, neuropathy, and arthritis presented to the clinic with significant difficulty in walking and Achilles tightness with worsening bilateral foot ulcerations. The ulceration showed resistance to healing despite using a variety of off-loading modalities. X-ray imaging demonstrated severe rocker-bottom flatfoot with end-stage midfoot osteoarthropathy. Wound culture of the midfoot prior to surgery detected proteus bacterial infection.

Outcomes: Preoperatively the soft tissue infection was treated with a combination of Doxycycline and Augmentin followed by operative midfoot resection of exostosis bone overgrowth, as well as bilateral Achilles tendon lengthening. During the operation, an Integra graft was utilized to regrow new skin with minimal scarring. An Adaptic sterile dressing with a fiberglass posterior splints were applied bilaterally. X-rays demonstrated clean resectioning of bone without any signs of infection. 

Conclusion:

Surgical resection of the midfoot bone growth/exostosis helped taking pressure off the skin and allowed the wound to heal without recurrence.  Lengthening of the Achilles tendon helped destress the forces on the midfoot and minimized the potential for further breakdown and progression of the flatfoot. Postoperatively the weekly dressing changes and treatment of the ulcerations with Silvadene antibiotic cream, Adaptic sterile dressing, and fiberglass posterior splint, kept the tissue healthy and viable.