[Management of midfoot instability in Charcot foot with the ring fixator : Use of a hybrid technique with internal and external stabilization].

OBJECTIVE: Combination of external and internal fixation for improvement of stabilization in midfoot arthrodesis. INDICATIONS: Charcot foot of the midfoot with/without (infection-free) ulceration. CONTRAINDICATIONS: Severe anesthesiological risks in multimorbid patients; untreated symptomatic peripheral arterial occlusive disease; severe soft tissue infection and defect with the necessity of amputation. SURGICAL TECHNIQUE: Performing subtractive resection arthrodesis of the midfoot with locking plates and screws combined with an external ring fixator of the foot and lower leg. POSTOPERATIVE MANAGEMENT: Postoperative partial weight bearing with sole contact and walking frame for 3 months. Then removal of external fixator, CT scan and based on the result, staged increasing of stress load with short-leg cast over a period of 4-6 weeks. Podomechanotherapy with full weight bearing.
RESULTS: With this surgical procedure, sufficient stabilization with fully load bearing, plantigrade foot with podomechanotherapy with the help of a combined internal and external fixation is possible. Complications (pin-tract infection or dislocation) exist, but they can be controlled. High healing rate of ulceration was achieved by bony position correction and stabilization.