Integrated mechanical and metabolic limb salvage for advanced diabetic Charcot hindfoot collapse with non-traumatic calcaneal fracture: an 8-year follow-up case report
Abstract
BACKGROUND
Advanced Charcot neuro-osteoarthropathy involving the hindfoot is associated with severe deformity, instability, ulceration, infection, and major lower-limb amputation. Non-traumatic calcaneal fracture associated with diabetic Charcot hindfoot collapse is uncommon and difficult to treat because of neuropathy, impaired bone quality, tendon imbalance, soft tissue compromise, and a high risk of fixation failure. Reports describing long-term functional limb preservation in patients with advanced Charcot hindfoot collapse associated with severe metabolic bone impairment remain limited.
CASE PRESENTATION
A 63-year-old Japanese woman with a 36-year history of type 1 diabetes mellitus presented with progressive right hindfoot deformity and ulceration without major trauma. Radiographs and computed tomography demonstrated advanced Charcot hindfoot collapse with a non-traumatic calcaneal fracture classified as Eichenholtz stage III and Brodsky type 3B. Preoperative evaluation demonstrated severe vitamin D deficiency and elevated bone turnover markers. The patient underwent corrective osteotomy of the calcaneus, Achilles tendon Z-lengthening, internal fixation with headless compression screws, autologous iliac bone grafting, and circular external fixation. A staged postoperative unloading protocol was used, followed by gradual protected loading. Sequential metabolic therapy was administered after surgery. Bone union was achieved at approximately 3 months, and the external…
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