Clinical study on Ilizarov technique combined with steel needle internal fixation for 12 patients with Charcot neuroarthropathy of foot and ankle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Pu , GUAN Hua , FENG Enhui , LIANG Jiachang , XU Yiyin , HE Jianbo , HUANG Weiming ,  XIE Jiewei

Department of Foot and Ankle Trauma, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou Guangdong, 510120, P. R. China;

Corresponding author：

XIE Jiewei, Email: gdszyycszhk@163.com

Keywords：

Charcot neuroarthropathy; foot and ankle; Ilizarov technique; steel needle; arthrodesis

DOI：

10.7507/1002-1892.202503098

Video：

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Objective To evaluate the short-term effectiveness of Ilizarov technique combined with steel needle internal fixation in treating Charcot neuroarthropathy (CN) of the foot and ankle. Methods Between June 2020 and December 2023, 12 patients with Eichenholtz stage Ⅲ CN of the foot and ankle were treated with Ilizarov technique and steel needle internal fixation. There were 9 males and 3 females with an average age of 48.6 years (range, 19-66 years). The disease duration ranged from 1 to 16 months (mean, 6.8 months). Ankle joint involvement predominated in 7 cases, while midfoot involvement occurred in 5 cases; 3 cases presented with skin ulceration and soft tissue infection. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 31.2±9.0, 36-Item Short-Form Health Survey (SF-36) Physical Component Summary (PCS) score was 32.6±6.8, and Mental Component Summary (MCS) score was 47.8±8.4. Postoperative assessments included wound healing, regular X-ray film/CT evaluations of fusion status, and effectiveness via AOFAS and SF-36 PCS/MCS scores. Results All operations were successfully completed without neurovascular complications. Two patients experienced delayed wound healing requiring intervention, and the others achieved primary healing. All patients were followed up 15-43 months (mean, 23.3 months). Imaging confirmed successful joint fusion within 13-21 weeks (mean, 16.8 weeks). At last follow-up, the AOFAS score was 72.5±6.4, and the SF-36 PCS and MCS scores were 63.2±8.4 and 76.7±5.3, respectively, all of which improved compared to preoperative levels, with significant differences (P<0.05). Conclusion Ilizarov technique combined with steel needle internal fixation effectively restores walking function and achieves satisfactory short-term effectiveness in CN of the foot and ankle.

1.	Yates TH, Cooperman SR, Shofler D, et al. Current concepts underlying the pathophysiology of acute Charcot neuroarthropathy in the diabetic foot and ankle. Expert Rev Clin Immunol, 2020, 16(8): 839-845.
2.	林晓东, 汪鑫, 刘洪亮, 等. 夏科氏足/踝关节病的研究进展. 实用骨科杂志. 2019, 25(11): 1004-1008.
3.	岳洋, 冯慧, 刘培珑, 等. 足踝部糖尿病夏科神经性关节病的临床诊治进展. 中国修复重建外科杂志, 2023, 37(11): 1438-1443.
4.	Bajuri MY, Ong SL, Das S, et al. Charcot neuroarthropathy: Current surgical management and update. A systematic review. Front Surg, 2022, 9: 820826. doi: 10.3389/fsurg.2022.820826.
5.	Hester T, Kavarthapu V. Etiology, epidemiology, and outcomes of managing charcot arthropathy. Foot Ankle Clin, 2022, 27(3): 583-594.
6.	Martin B, Chow J. The use of circular frame external fixation in the treatment of ankle/hindfoot Charcot neuroarthropathy. J Clin Orthop Trauma, 2021, 16: 269-276.
7.	Zhu YL, Guo BF, Zang JC, et al. Ilizarov technology in China: a historic review of thirty-one years. Int Orthop, 2022, 46(3): 661-668.
8.	郭保逢, 秦泗河. 软骨发育不全短臂畸形的延长与重建进展. 中国修复重建外科杂志, 2025, 39(1): 118-122.
9.	秦泗河, 郭保逢, 郑学建, 等. 22 062 例足踝畸形患者临床特点分析(秦泗河矫形外科数据库1978 年5 月25 日—2020 年12 月31 日). 中国修复重建外科杂志, 2023, 37(1): 74-80.
10.	Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res, 2015, 473(3): 1168-1171.
11.	Schneider W, Jurenitsch S. Normative data for the American Orthopedic Foot and Ankle Society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system. Int Orthop, 2016, 40(2): 301-306.
12.	Bajuri MY, Manas AM, Zamri KS. Functional outcomes of tibiotalocalcaneal arthrodesis using a hindfoot arthrodesis nail in treating Charcot’s arthropathy deformity. Front Surg, 2023, 9: 862133. doi: 10.3389/fsurg.2022.862133.
13.	Galhoum AE, Abd-Ella MM, Zahlawy HE, et al. Infected unstable Charcot ankle neuroarthropathy, any hope before amputation? A prospective study. Int Orthop, 2022, 46(7): 1481-1488.
14.	Ersin M, Demirel M, Chodza M, et al. Mid-term results of hindfoot arthrodesis with a retrograde intra-medullary nail in 24 patients with diabetic Charcot neuroarthropathy. Acta Orthop, 2020, 91(3): 336-340.
15.	马春锋, 牛科润, 韩雨凇, 等. 夏科氏足/踝关节病的最新研究进展. 生物骨科材料与临床研究, 2023, 20(5): 80-85.
16.	Monteagudo M, Martínez-de-Albornoz P. Deciding between ankle and tibiotalocalcaneal arthrodesis for isolated ankle arthritis. Foot Ankle Clin, 2022, 27(1): 217-231.
17.	Strotman PK, Reif TJ, Pinzur MS. Charcot arthropathy of the foot and ankle. Foot Ankle Int, 2016, 37(11): 1255-1263.
18.	张磊, 王新卫, 陈雨声, 等. 结合Ilizarov技术行胫跟或胫距跟融合同期治疗踝关节感染并骨缺损疗效分析. 中国修复重建外科杂志, 2017, 31(9): 1059-1063.
19.	Hartmann R, Grubhofer F, Waibel FWA, et al. Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis. J Orthop Res, 2021, 39(10): 2151-2158.

1. Yates TH, Cooperman SR, Shofler D, et al. Current concepts underlying the pathophysiology of acute Charcot neuroarthropathy in the diabetic foot and ankle. Expert Rev Clin Immunol, 2020, 16(8): 839-845.
2. 林晓东, 汪鑫, 刘洪亮, 等. 夏科氏足/踝关节病的研究进展. 实用骨科杂志. 2019, 25(11): 1004-1008.
3. 岳洋, 冯慧, 刘培珑, 等. 足踝部糖尿病夏科神经性关节病的临床诊治进展. 中国修复重建外科杂志, 2023, 37(11): 1438-1443.
4. Bajuri MY, Ong SL, Das S, et al. Charcot neuroarthropathy: Current surgical management and update. A systematic review. Front Surg, 2022, 9: 820826. doi: 10.3389/fsurg.2022.820826.
5. Hester T, Kavarthapu V. Etiology, epidemiology, and outcomes of managing charcot arthropathy. Foot Ankle Clin, 2022, 27(3): 583-594.
6. Martin B, Chow J. The use of circular frame external fixation in the treatment of ankle/hindfoot Charcot neuroarthropathy. J Clin Orthop Trauma, 2021, 16: 269-276.
7. Zhu YL, Guo BF, Zang JC, et al. Ilizarov technology in China: a historic review of thirty-one years. Int Orthop, 2022, 46(3): 661-668.
8. 郭保逢, 秦泗河. 软骨发育不全短臂畸形的延长与重建进展. 中国修复重建外科杂志, 2025, 39(1): 118-122.
9. 秦泗河, 郭保逢, 郑学建, 等. 22 062 例足踝畸形患者临床特点分析(秦泗河矫形外科数据库1978 年5 月25 日—2020 年12 月31 日). 中国修复重建外科杂志, 2023, 37(1): 74-80.
10. Rosenbaum AJ, DiPreta JA. Classifications in brief: Eichenholtz classification of Charcot arthropathy. Clin Orthop Relat Res, 2015, 473(3): 1168-1171.
11. Schneider W, Jurenitsch S. Normative data for the American Orthopedic Foot and Ankle Society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system. Int Orthop, 2016, 40(2): 301-306.
12. Bajuri MY, Manas AM, Zamri KS. Functional outcomes of tibiotalocalcaneal arthrodesis using a hindfoot arthrodesis nail in treating Charcot’s arthropathy deformity. Front Surg, 2023, 9: 862133. doi: 10.3389/fsurg.2022.862133.
13. Galhoum AE, Abd-Ella MM, Zahlawy HE, et al. Infected unstable Charcot ankle neuroarthropathy, any hope before amputation? A prospective study. Int Orthop, 2022, 46(7): 1481-1488.
14. Ersin M, Demirel M, Chodza M, et al. Mid-term results of hindfoot arthrodesis with a retrograde intra-medullary nail in 24 patients with diabetic Charcot neuroarthropathy. Acta Orthop, 2020, 91(3): 336-340.
15. 马春锋, 牛科润, 韩雨凇, 等. 夏科氏足/踝关节病的最新研究进展. 生物骨科材料与临床研究, 2023, 20(5): 80-85.
16. Monteagudo M, Martínez-de-Albornoz P. Deciding between ankle and tibiotalocalcaneal arthrodesis for isolated ankle arthritis. Foot Ankle Clin, 2022, 27(1): 217-231.
17. Strotman PK, Reif TJ, Pinzur MS. Charcot arthropathy of the foot and ankle. Foot Ankle Int, 2016, 37(11): 1255-1263.
18. 张磊, 王新卫, 陈雨声, 等. 结合Ilizarov技术行胫跟或胫距跟融合同期治疗踝关节感染并骨缺损疗效分析. 中国修复重建外科杂志, 2017, 31(9): 1059-1063.
19. Hartmann R, Grubhofer F, Waibel FWA, et al. Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis. J Orthop Res, 2021, 39(10): 2151-2158.

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