Year: 2026
Type: article
Study design: Case Report
Abstract: INTRODUCTION: Charcot neuro-osteoarthropathy (CN) is a complication of distal polyneuropathy. Isolated calcaneal involvement (type 5 by Sanders–Frykberg) is rare, with an incidence of 1.8%–5%, and delayed diagnosis occurs in up to 25% of cases. According to systematic reviews, although hindfoot involvement is less common than midfoot disease, it causes more severe gait biomechanical disturbances and is more challenging to treat. Given the rarity of this condition and the limited number of studies on surgical management, we analyzed the outcomes of orthopedic correction for isolated calcaneal deformity in CN patients. CASE DESCRIPTION: We included eight patients with isolated calcaneal CN. Seven underwent open reconstruction with internal fixation; one had closed correction with Ilizarov frame fixation. Full offloading was maintained until radiographic consolidation, followed by frame removal and transition to conservative immobilization. No early postoperative complications occurred after open reduction (n = 7). Partial weight-bearing was allowed at 4.5 months. In one patient, non-compliance with offloading led to external fixator instability, requiring premature removal and conversion to a cast. In another patient (Eichenholtz stage I, internal fixation), full weight-bearing precipitated CN manifestation in the ankle joint, requiring cast immobilization for 4 months and subsequent transition to custom footwear; no repeat surgery was needed. Mean follow-up was 3.1 ± 0.2 years. CONCLUSION: The hindfoot is the primary weight-bearing area; its involvement causes pronounced biomechanical disturbances that require prolonged, complex treatment. Its rarity calls for careful differential diagnosis. Mean BMI in our cohort (25.8 kg/ m²) was lower than published values, suggesting a lesser role of BMI in isolated calcaneal CN or compensatory effects of other mechanisms. Despite the limited sample size, our findings support the effectiveness of reconstructive techniques in Sanders type 5 lesions. Surgical decisions should take patient compliance into account. Further multicenter studies are needed to develop unified guidelines.
DOI: 10.17816/vto686704
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7204248902