Charcot Reconstruction

[DrYES]

If possible, could any of the physicians (who have unknown to them been very instrumental in my decision to pursue podiatry, which is much appreciated) on the message board provide an overview of Charcot Reconstruction procedure. I have been able to study/understand almost every procedure performed by podiatric surgeons except for Charcot Reconstruction, and this is mostly out of curiousity.

A few questions:

(1) What is the optimal prognosis following a successful surgery and recovery?

(2) Is this a long and tedious procedure, because it almost seems impossible and absurd?

(3) How often is this procedure performed?


I sincerely appreciate your response. I once again thank many of the surgeons on the message (podfather, kidsfeet, jonwill, PADPM, and others) who continually respond quickly and thoroughly to so many questions. I have begun interviews at Podiatric Medical Schools and I am VERY excited about the my personal career and the direction of the profession.

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[347932]

If possible, could any of the physicians (who have unknown to them been very instrumental in my decision to pursue podiatry, which is much appreciated) on the message board provide an overview of Charcot Reconstruction procedure. I have been able to study/understand almost every procedure performed by podiatric surgeons except for Charcot Reconstruction, and this is mostly out of curiousity.

A few questions:

(1) What is the optimal prognosis following a successful surgery and recovery?

The optimal prognosis is limiting post operative short and long term disability, return to full function and avoidance of recurrence.

(2) Is this a long and tedious procedure, because it almost seems impossible and absurd?

It is a long and tedious process and it's no wonder we call it "marrying" your patient. Once you do one of these on a patient they are generally yours for the remainder of their lives, however long that may be.

(3) How often is this procedure performed?

That is more dependent on the surgeon than the patients. Some prefer to not do them at all. Some jump in a bit too quickly. Some assess the situation, try everything they can conservative and use the procedure as a salvage only. Some do them preventatively. It really depends on your skill set and comfort level. It also depends on how good your malpractice is in some cases (no I'm not kidding).


I sincerely appreciate your response. I once again thank many of the surgeons on the message (podfather, kidsfeet, jonwill, PADPM, and others) who continually respond quickly and thoroughly to so many questions. I have begun interviews at Podiatric Medical Schools and I am VERY excited about the my personal career and the direction of the profession.

Congrats on your career path and best of luck to you!

 

[Feli]

The prognosis is poor no matter how skilled the surgeon. The patients have a history of poorly controlled diabetes with neuropathy... and usually also at least of the following: soft tissue or wound infection on that foot, PAD, renal dz, obesity, etc. You will see poor bone stock, hardware failure, hardware infections, wound problems, and AVN quite frequently in Charcot recons - even if they're well performed.

IMO, you need skilled surgeons for this, and even then, you basically tell the patient they're undergoing a basically "last ditch" effort at functional limb salvage. If the foot is able to go into a DM custom shoe or walker, do that. Charcot recon is basically for a compliant patient with an unstable deformity or deformed foot with recurrent or nonhealing ulcer caused by bony prominence. The goal is basically just a foot that can function ok in a DM shoe or CROW walker after healing. If they're a smoker or the least bit noncompliant, then Charcot recon is pretty much a fool's undertaking... in those cases, it's time for total contact casts or offload walker until they get their amp.

As for how much it's done, that depends on the practice. Guys who do a lot of wound care or a heavy diabetic practice will get some candidates. Kidsfeet put it well: some guys do a lot of Charcot recon, and some avoid it like the plague. Ideally, you take each case individually and eval the pathology and patient's healing + compliance potential (with DM control, not just post op course).