ऑर्थोटिक ऑफलोडिंग से स्थिरता प्राप्त न होने पर अस्थिर चार्कोट न्यूरोपैथिक फुट

References

DOI: 10.1007/s40266-025-01234-0

• Patients suffering from unstable CNO of Sanders-Frykberg types I-III, stable Sanders-Frykberg type IV, V or more advanced CNO destructions are empirically treated by Sarmiento orthoses-dynamic or non-dynamic.
• In some cases, however there is more advanced destruction of the foot combined with joints instability and not so rarely with diabetic foot ulcers and osteomyelitis.
• More extensive reconstruction aims to create a stable, plantigrade foot through arthrodesis procedures.
• This approach is particularly valuable for severely unstable feet or those with recurrent ulceration after failed conservative or simpler surgical treatments.
• External fixators, particularly circular frames, such as the Ilizarov apparatus, provide solutions for complex cases requiring: (i) management of concurrent soft tissue problems or infection, (ii) gradual correction of severe deformities or (iii) supplementation of internal fixation.
• Pinzur et al. achieved 95.7% limb salvage with a protocol involving radical resection of bone, correction of deformity, external fixation and culture-specific antibiotic therapy.
• The transition to protected weight-bearing can be initiated when bony fusion is evident (8-14 weeks).
• Serial MRI monitoring every 3 months until resolution of inflammatory changes (average 8.3 months) helps determine appropriate immobilization duration.