Surgical management of Charcot neuroarthropathy of the foot and ankle: a systematic review

Background: Charcot neuroarthropathy (CN) of the foot and ankle is an extremely challenging clinical dilemma and surgical management can be highly complicated. The current literature on this topic is comprised of manuscripts that are retrospective case series and expert opinions. Furthermore, surgery in patients with CN of the foot and ankle is guided by studies with low levels of evidence to support our current surgical practices. Methods: A Medline/CINAHL search was performed and a systematic review of articles discussing the surgical management of CN was undertaken. Results: Ninety-five articles fit the inclusion criteria for our study. As hypothesized, all reports detailing the surgical management of Charcot neuroarthropathy constituted Level IV or V evidence. Conclusion: Surgical algorithms for the treatment of CN of the foot are based almost entirely on level four or five evidence. Uncontrolled retrospective case series and case reports guide the use of exostectomy, fusion, and Achilles tendon lengthening for CN. There is inconclusive evidence concerning timing of treatment and use of different fixation methods. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice. Level of Evidence: II, Systematic Review