Conservative versus Surgical Management of Charcot Foot and Ankle: A Systematic Review of Literature

Abstract

Introduction: Charcot neuropathy (CN) is a progressive, non-infectious neuro-osteoarthropathy of the bones and joints in patients with sensorial neuropathy leading to destruction of the foot architecture. To date, best practice assessment, diagnosis and management of CN appears to be influenced more by expert consensus than a meticulous evidence-base. This may be because CN is considered one of the rarer complications of those caused by diabetes and thus tends to fall outside of the existing national guidelines or systematic reviews on diabetic foot complications. This paper therefore aims to systematically review current relevant literature and develop an evidence-based clinical pathway for the management of Charcot foot and ankle. Aim of the work: To review the literature about the management of Charcot foot and ankle and develop an evidence based opinion about the advantages and disadvantages of conservative and surgical management of Charcot foot and ankle. Materials and methods: Electronic databases (PubMed) will be systematically searched for literature discussing the management of Charcot foot and ankle.After searching PubMed with the key words and applying the inclusion criteria we found 21 papers, 7 of them concerning the conservative management, 12 of them concerning the surgical management and 2 of them concerning both conservative and surgical management of Charcot arthropathy. Results: different modalities of treatment are compared concerning the outcomes of interest which are: foot ulceration, resolution of acute inflammatory symptoms, postoperative co plication and achievement of union and plantigrade foot Conclusion: surgical management has its complications however it is required to correct deformities and achieve plantigrade foot. Arthrodesis by external fixation is the preferred method to use as it has better results and less complications.