Surgical stabilization of nonplantigrade Charcot arthropathy of the midfoot.

Fifty-one adults (28 men, 23 women) with Charcot arthropathy of the midfoot underwent surgical correction. Mean patient age was 58 years (SD, 9.9 years). All affected feet were nonplantigrade and at high risk for ulcers. Before surgery, mean lateral talar-first metatarsal angle was 27.6 degrees (SD, 12.8 degrees). Corrective osteotomy was performed to achieve plantigrade alignment. At minimum 1-year follow-up, 44 of 51 patients had the desired outcome. Mean lateral talar-first metatarsal angle had decreased to 6.4 degrees (SD, 7.7 degrees). Despite its associated high complication rate, corrective osteotomy can help patients become ulcer- and infection-free and maintain their ability to walk with commercially available therapeutic footwear. A treatment algorithm is presented.