The Role of Internal Offloading and Rotational Flap Closure of Charcot Arthropathy-Related Midfoot Ulcers

There are several interesting approaches to this problem. In the authors' experiences, internal foot hardware has had significant difficulty stabilizing the poor bone integrity that is a hallmark of Char-cot foot; in addition, very few foot and ankle surgeons are likely to put hardware into a foot that has an open wound. External fixation with a walking external frame has been described, which the authors occasionally use. In the treating center's experience, few patients choose external fixation. In part, this is due to it requiring a 3-month time commitment of having the frame in place. Anecdotally the results are very good for complete offloading with a frame and rotational flap creation. However, this is a greater commitment that most ambulatory patients are willing to agree to. Therefore, the authors presented the option of internal offloading and soft tissue coverage, ideally with rotational flap or adjacent myocutaneous flap as a feasible and well-accepted alternative.