Adjunctive lateral ankle stabilization in midfoot Charcot reconstruction for ankle joint preservation

Ankle Charcot deformity can occur after midfoot Charcot reconstruction, especially when patients present with hindfoot varus or pre-existing ankle instability. The osseous reconstruction consisting of midfoot intramedullary beaming and adjunctive procedures such as subtalar joint fusion influences the biomechanics of the ankle joint. In patients with preoperative hindfoot varus or ankle instability, the frontal plane deformity at the subtalar joint could predispose to excessive forces through the collateral ligaments of the ankle joint complex. This case series of five patients (six limbs) lateral ankle stabilization was used to contain and stabilize these deforming forces and permit the ankle to function anatomically. After Charcot reconstruction there were no amputations, recurrences, new Charcot breakdown or ulcerations. Postoperatively 100% (5/5) of patients were fully or partially ambulatory compared to solely 40% (2/5) preoperatively. Soft tissue infection requiring repeat surgical debridement occurred in 33.33% (2/6) of surgical limbs, and hardware failure occurred 16.67% (1/6) of patients. While lateral ankle stabilization is not inherently a novel concept, it's use as an adjunctive procedure in Charcot midfoot reconstruction is unique. The lateral ankle stabilization functions to prevent excessive frontal plane instability at the ankle joint and has been demonstrated in our investigation to mitigate the risk for subsequent ankle joint Charcot.