Surgical reconstruction in a single patient with bilateral avascular necrosis of the talus

Charcot neuroarthropathy (CN) is a debilitating disease that can lead to substantial deformity of the foot and ankle, chronic ulcerations, and loss of limb. The condition often requires large limb salvage reconstructions of the foot and ankle to correct equinovarus deformities as well as create a stable, plantigrade foot. We present a unique case involving a single patient who underwent two different surgical approaches for CN and avascular necrosis (AVN) of the talus. The patient's right lower extremity, which involved removal of the talus and fixation utilizing a blade plate, continues to have a stable plantigrade foot without any skin breakdown over five years of follow up. The left lower extremity, which preserved the talus and underwent primary tibiotalocalcaneal (TTC) fusion with intramedullary (IM) rod, developed a wound along the lateral column and recurrence of her equinovarus deformity at four years follow up. Although both limbs have a brace-able, functional foot today, the left foot had an increased incidence of complication as demonstrated by an interval fracture of the rod, subtalar joint (STJ) nonunion, and skin breakdown. We seek to evaluate the use of a blade plate versus intramedullary rod for treatment of equinovarus deformity secondary to CN.