Charcot Foot is defined as a neuropathy induced condition which results in the weakening of the ankle joint, and ultimately the flattening of the feet. With this condition patients lose some of the protective sensations in the foot, that then leads to destruction of foot, ankle joints and surrounding bone. Hindfoot, midfoot fusions with internal and/or external fixation can be used to restore balance in the foot and reduce pain for our patients. This type of fusion (arthrodesis) involves the permanent stiffening of the bones, together with plates, screws, staples and external fixators.

Indications / Candidacy

Charcot joint usually occurs secondary to an underlying neuropathy (nerves do not function properly) and results in destruction of joints, often in the foot in ankle but this can occur in other joints as well. This condition may affect patients with Diabetic Neuropathy who have reduced sensation or difficulty feeling their extremities. It has also been linked to conditions such as syphilis, alcoholism, peripheral nerve injuries, and spina bifida.
Because diabetic neuropathies often affect patients’ legs, the foot and ankle are common locations for Charcot joints.

Good Candidates for hindfoot and midfoot fusions for charcot joints with internal and or external fixation may have:

  • Healed Charcot with underlying deformities of the foot and ankle
  • Ulceration secondary to underlying foot deformities
  • Un-shoeable foot deformities
  • Failure to respond to more conservative treatment measures

Treated Conditions

The Canadian Limb Lengthening Center offers a team of experienced surgeons, nurses and physiotherapists that make patients feel supported throughout their entire treatment process. Our ability to treat complex orthopedic conditions with a holistic approach gives our patients the best possible outcomes. We pride ourselves in providing highly specialized, expert care. To learn more about Charcot foot follow the link below:


Charcot foot

Surgical Technique

Hindfoot, midfoot fusions can be performed using internal and or external fixation. Internal fixation devices may include plates and screws, and solid intramedullary fusion bolts to stabilize the bones. External fixation may include a unilateral, ring, or hybrid fixators that stabilize the bone with hardware that is found outside the body. The type of fixation used may depend on a patient’s bone quality but often a combination of internal and external fixation is used. In some cases, a two-stage fixation strategy may be employed to first correct deformity.

Internal fixation:

  1. General or spinal anesthesia is typically used for this surgery.
  2. An incision is made to access and remove any excess bones, prepare the joint surfaces for fusion and correct the underlying foot/ankle deformities .
  3. If bones are fragmented and/or dislocated, this correction will be made acutely
  4. Hardware such as screw, bolt or nail fixation is used to hold the fusion in place
  5. Combined use of an external fixation is then considered as needed.

External fixation

  1. General or spinal anesthesia is typically used for this surgery.
  2. During surgery an external fixation device is attached to the deformed bones of the foot
  3. This device allows for adjustments to be made outside of the operating room
  4. Based on your surgical plan, these adjustments will be made gradually and allow for correction in multiple planes.
  5. External fixation allows patients to weight bear earlier in their treatment process, which can avoid complications with regards to patient compliance.
  6. Once alignment is achieved, the patient may be brought back to the operating room for additional internal fixation


A normal side effect from ankle, hindfoot, midfoot fusions is reduced range of motion in the joint. For most patients this isn’t a major problem, as they are happy to have minimized or eliminated pain and correction of their deformity. Pain relief and deformity correction allows most patients to return to some activities, increase function and mobility, a higher tolerance for walking and a better quality of life. A full recovery may take up to twelve months.

Potential Complications

As with any surgical procedure, hindfoot and midfoot fusions with internal and or external fixation can have difficulties and complications. In most cases, our team of specialists can address these concerns without compromising the end results or outcome. Complications and side effects may include:

  • Pin site Infection
  • Non-union or wound healing problems
  • Damage to nearby nerves
  • Blood clot
  • Fixation failure
  • Continued deformity of the foot and ankle
  • Arthritis or destruction of nearby joints

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre and post appointment dates
  • Make arrangements for personal care givers

Post-Operative Care

  • Ensure that pin site and fixation devices remain clean
  • During the first 6-8 weeks, crutches are to be used and limited weight is to be put on the foot depending on what fixation was used
  • At approximately 8-12 weeks, or once fusion is achieved, an operation will be scheduled to remove the external fixation device
  • After this time, a cast or brace may be used, patient is still recommended to use crutches for balance and full weight bearing
  • Incremental increases in activity will take place over the next six months-1 year

Patients who will undergo this procedure with External Fixator should read:

External fixator Immediate post-operative care
Struts adjustments
Pin site care and infection protocol

Follow-ups after surgery

  • Patients are seen at post-operative week one for dressing change
  • Two weeks after another follow up is used for incision and external fixation care

Case studies

46 year old man with deformity of the foot and ankle with charcot
76 year old lady with ankle fracture


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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.