ILIZAROV FRAME IN THE MANAGEMENT OF CHARCOT JOINT DISEASE: THE CHERTSEY EXPERIENCE

Background: Charcot arthropathy is a condition related to the loss of protective sensation of a joint. It normally presents in its early inflammatory phase, followed by bone destruction. Recognised treatment for this is total contact casting (TCC). However, in a small group this may be unsuccessful in preventing deformity progression. TCC can also be difficult in the presence of recalcitrant ulceration and deformed feet. Method: 40 patients, with a diagnosis of Charcot foot, were followed from presentation in our unit over 3 years. An Ilizarov frame was used for two groups: those in the early phase who showed progressive deformity despite TCC (5 patients) and those with chronic ulceration (4 patients). Frames were modified to allow weight-bearing on the frame (with no foot contact). All other patents were treated with TCC. Results: There were no amputations or cases of osteomyelitis. The Ilizarov frame successfully prevented further deformity when applied in the inflammatory phase. In patients with ulceration, deformity correction with a modified frame maintained correction and allowed the ulcers to heal rapidly whilst weight bearing. Conclusion: Our series shows the Ilizarov frame can be used in the management of Charcot to prevent deformity progression and allow recalcitrant ulcers to heal following deformity correction.