Power of the 4th Opinion: The Charcot Foot

Over the last year, I completed the care of a patient who came to me at the referral of a colleague for a 4th opinion. Three years prior she had sustained a fracture in her heel bone. She underwent surgery to fix the broken bone which ended up failing miserably. Given this failure, she was referred to another provider for further management. This provider attempted a corrective fusion of her hindfoot and midfoot. Unfortunately, the surgery left her with a deformed, non-functional foot that continuously ulcerated due to pressure. This ulceration lead to multiple infections and subsequent surgeries to clean out of the infection. Luckily, she was referred to a colleague of mine for 3rd opinion after hospitalization for infection. During her most recent hospitalization, it was recommended she undergo below knee amputation. She adamantly refused seeking other options. None were offered. Seeking any alternative to amputation, my colleague recommended she come see me for evaluation. 

After many consultations and discussion of options, we elected to proceed with a staged reconstructive protocol. Stage 1 would be corrective tendon balancing and bone osteotomies to allow gradual correction of her severe deformity. Also, a rotational skin flap was done to eradicate the recurrent ulceration. Once we were able to establish a healed skin envelope and aligned foot, we would then proceed with definitive fusion and alignment of her foot.

After 3.5 months of recovery and 2 major reconstructive surgeries, the patient is functionally ambulating in a protective brace and shoes. She is in physical therapy for many more months to restore functional strength of the limb due to prolonged deconditioning from her prolonged recovery. She remains ulcer free, and has had a quality of life restored that she hasn’t experienced in over 3 years. Next on the horizon, a return to work, in normal shoes, and driving her car again. 

These types of cases are the biggest reason I entered medicine. When all hope feels lost, I take great heart to try and help patients find the solution. As a team, we can accomplish great things and get you where you want to be.

Author

Dr. Zachary Flynn DPM, FACFAS Fellowship Trained Foot & Ankle Surgeon