Naohiro Shibuya, DPM, MS, FACFAS shared the latest evidence surrounding Charcot reconstruction at the Midwest Podiatry Conference in Chicago on April 9, 2022. He related that there are multiple considerations foot and ankle surgeons must undertake when planning the approach for this condition, including:

·       Determining whether to pursue planing versus reconstruction versus amputation;

·       If undertaking reconstruction, evaluating the benefits and risks of isolated arthrodesis versus a superconstruct;

·       Planning the timing of reconstruction (acute versus delayed); and

·       Whether to use internal,external fixation or both.

Dr. Shibuya also presented some recent literature trends that he feels reflects current thinking on the surgical approach to Charcot.

“Amputation is becoming more attractive considering (metrics on) quality-of-life, cost-effectiveness and function,” he says. “If (one) decides to reconstruct, my observation is that more surgeons treat acutely, more surgeons use superconstructs and more surgeons stopped using external fixation.” 

In his experience, he says he feels amputation is the superior choice in many scenarios. During his lecture, however, he detailed exceptions to this, since each case is unique. Dr. Shibuya, a Professor of Surgery at Texas A & M University College of Medicine and newly named Editor-in-Chief of The Journal of Foot and Ankle Surgery, says there are three top points he hopes podiatrists take away from his lecture. First, he wants to stress that amputation is a viable option for many patients with Charcot neuroarthropathy. Secondly, he hopes clinicians understand that “limb salvage” is not necessarily the goal for many patients. Lastly, he feels that the focus for Charcot should center around a medical, rather than a surgical, approach.