الفهرس 
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Abstract
Charcot neuroarthropathy of the foot is a systemic disease which affects the musculoskeletal system leading to joint destruction. It is usually misdiagnosed in its active form leading to late diagnosis. Ulceration and infection are common with CN and may lead amputation if not managed properly. This study aims to assessment of the outcome of patients with CN of the foot and ankle clinically, functionally and radiologically. The primary outcome is assessment of the rate of union. The secondary outcome is assessment of deformity correction in these patients in addition to evaluation of the functional outcome using the American Orthopedic Foot and Ankle Society AOFAS score. Many theories have been proposed to explain the pathogenesis of CN such as the neurovascular theory, the neurotraumatic theory, the combination theory. A new theory has been recently proposed which attribute CN to uncontrolled inflammation. Several authors have anatomically classified the characteristics of CN such as Sanders and Frykberg classification, Rogers classification and the most commonly used, Brodsky classification. The usual presentation is warmness, swelling and/ or erythema of the affected limb. The affected extremity is palpably warmer than the unaffected foot and is 3°to 5°C warmer on the affected side. It can be differentiated from infection by dependent redness, bounding pulses and loss of protective sensation. Anteroposterior and lateral weight-bearing plain radiographs are useful for following disease progression through the different stages. CT is more sensitive than plain X rays for detecting osteomyelitis. MRI detects of fine changes in the early stages of active CN when the radiographic findings could still be normal. Total contact cast remains the standard method of immobilization in active charcot arthropathy. Various surgical techniques have been employed for stabilization of the affected limb such as exostectomy and Achilles tendon lengthening and arthrodesis by either external or internal fixation methods. Amputation has been used in case of complicated late stage charcot foot deformities with concomitant uncontrolled infection. Our study is retrospective case series which included patients who underwent surgical correction of deformity in the foot and/ ankle caused by diabetic CN. They were 13 males and 11 females of different Brodsky types. These cases were assessed clinically and radiologically then they did the AOFAS scale to assess their functional outcomes. Different approaches have been used according to the soft tissue condition at the time of intervention and the used method of fixation. We used the lateral transfibular approach, the anterolateral approach and the anterior approach for the hindfoot. For the midfoot, we used two separate approaches to the medial and lateral columns of the foot. Various fixation methods were used such as the ilizarov external fixator, plates and screws and retrograde calacneo- talo tibial nail. Union of the fusion sites occurred in 23 of 24 patients (95.8%). Regarding radiological correction, significant improvement was noticed in the calcaneal pitch angle and the lateral tibio calcaneal angle in patients underwent hindfoot fusion. In the same context, significant improvement was noticed in the calcaneal pitch angle, anteroposterior and lateral talo first metatarsal angles and forefoot adductus angle in patients underwent midfoot fusion while no significant change in Hibb´s angle was noticed in these patients. Six of eight patients had their preoperative ulcers healed at the follow up. Mean of post-operative AOFAS was 74.67 ± 13.41. Various complications were noted in our series. They included infection (12.5%), stress fracture of the tibia (8.3%), recurrent ulceration (8.3%), reactivation of the CN (8.3) and aneurysm of the anterior tibial artery (4.1%). Our results were comparable to results reported in similar studies evaluating same outcomes regarding union rate, deformity correction, ulcer healing, AOFAS score and complication rate. CN is a common complication of diabetes mellitus leading to deformed feet and /or ankles in diabetic patients. Several points can be learned from this series. First, deformity correction is the main cornerstone to prevent ulcer reformation in these patients. Second, analysis of all components of the deformity, presence of ulcers, soft tissue condition as well as history of previous infection are the main determinants for the method of fixation. Third, no method of fixation has proved better results regarding union, radiological or clinical outcomes over other methods as long as the deformity was successfully corrected. Fourth, the patient should be informed about the possible complications of surgical correction of deformities caused by CN specially the possibility of infection as well as non-union. Finally, the use of orthoses may help to protect the surgically obtained correction and compensate for any residual deformity and to protect the skin of the sole.