Foot and Ankle Surgery
Volume 14, Issue 1 , Pages 26-31, 2008

Treatment of Charcot foot and ankle with a prefabricated removable walker brace and custom insole

  • Shawn Verity, MD

      Affiliations

    • Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
    • ,
  • Michael Sochocki, MD

      Affiliations

    • Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
    • ,
  • John M. Embil, MD, FRCPC

      Affiliations

    • Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
    • Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
    • ,
  • Elly Trepman, MD

      Affiliations

    • Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
    • Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
    • Department of Orthopaedic Surgery, Grand Itasca Clinic & Hospital, Grand Rapids, MN, United States
    • Corresponding Author InformationCorresponding author at: Health Sciences Centre, MS 673–820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada. Tel.: +1 204 787 4654; fax: +1 204 787 2989.

Received 20 November 2006; received in revised form 29 September 2007; accepted 3 October 2007.

Abstract 

Background

Removable walker braces have been used successfully to treat acute and chronic foot and ankle conditions including diabetic foot ulcers. We hypothesized that a removable walker brace may be successfully used in the management of the Charcot foot and ankle.

Methods

Twenty-five feet and ankles with Charcot arthropathy in 21 patients (bilateral in 4 patients) were treated with a prefabricated, pneumatic removable walker brace fitted with a custom orthotic insole. Follow-up data were collected from patient interview, examination, and radiography.

Results

Brace fitting was accomplished usually with a single visit to the prosthetist or pedorthist/orthotist. At the most recent evaluation, 17 (68%) feet and ankles had consolidation (stage III) of the Charcot arthropathy (average duration of brace use, 29±19 weeks) and were subsequently treated with rocker sole shoes, insoles, and ankle foot orthoses; 8 (32%) feet and ankles had ongoing brace treatment. Three feet developed new deformity during brace treatment, but average radiographic parameters of hindfoot to forefoot alignment had minimal change between initial and final radiographs at an average of 36±24 weeks after initial radiographic evaluation.

Conclusions

The prefabricated, pneumatic removable walker brace fitted with a custom insole was successful in the management of the Charcot foot and ankle and had a high satisfaction rate and safety profile despite frequent, albeit usually minor, complications.

Keywords: Diabetes, Neuropathy, Arthropathy, Treatment

 

PII: S1268-7731(07)00092-6

doi:10.1016/j.fas.2007.10.002

Foot and Ankle Surgery
Volume 14, Issue 1 , Pages 26-31, 2008

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