Treatment algorithm for Charcot foot and surgical technique with circular external fixation.

Background: Charcot neuroarthropathy (CNA), commonly known as Charcot foot, is one of the most debilitating complications of diabetes mellitus. Patients with plantar ulcer and osteomyelitis (OM) due to Charcot foot represent a high cost for health systems and society in general. The amputation risk for ulcerated Charcot patients is 12 times higher than general population under 65 years old.
Material and Methods: In this article we present the CNA treatment protocol we use in our center. We also make a detailed description of the surgical technique «single stage surgery» with circular external fixation.
Results: Our CNA treatment protocol covers the most common presentations of this severe neuropathic complication. With the «single stage surgery» using circular external fi xation we achieve an ulcer-free foot, successful treatment of the OM, correction of the deformity, diminished the cost of treatment, avoided amputation and prevented recurrence of the ulcer.
Conclusions: The use of a treatment algorithm based on the current literature, can be an invaluable tool in the treatment of these complex patients. The circular external fixation has proven to be the only reliable tool for treating complex Charcot foot in the context of poor bone stock, active ulcers, soft tissues problems and OM.