A method for preoperative planning of reconstructive intervention on the foot in case of severe deformity due to Charcot osteoarthropathy complicated by osteomyelitis

INTRODUCTION: The use of 3D technology has become widespread in various fields of medicine. 3D printing is used not only in the manufacture of individual implants, but also to create physical models necessary for preoperative preparation. Reconstructive surgery for complex foot deformities in patients with Charcot osteoarthropathy requires careful planning of surgical intervention.

CLINICAL CASE DESCRIPTION: Patient T., 62 years old, with type 2 diabetes mellitus and distal diabetic polyneuropathy, Charcot osteoarthropathy of the middle section of both feet, and a Wagner III grade plantar ulcerative defect of the left foot. A CT scan of the left foot was performed, based on which a 3D model of the foot was created. The plastic model of the foot was used to visually assess the nature of the deformity and the technical feasibility of arthrodesis. Resection arthrodesis was performed with an oscillating saw, and the foot model was fixed in a functionally advantageous position with pins. Intraoperatively, resection arthrodesis of the Lisfranc joint with bone autografting was performed. The duration of the operation was 1.5 hours. In the postoperative period, fixation with a posterior plaster splint was performed, followed by replacement with an total contact cast. At a follow-up examination 15 months later, no recurrence of deformation or ulcerative defects of the foot was detected. The patient walks in custom orthopedic shoes without additional support, using custom orthopedic diabetic insoles.

CONCLUSION: Reconstructive surgery for Charcot osteoarthropathy is a complex sphere of orthopedics. A method of preoperative planning using 3D modeling in the reconstruction of severe Charcot foot deformities provides a personalized approach and reduces the duration of surgical intervention.