Progressive Collapsing Foot Deformity Progressive Collapsing Foot Deformity (PCFD), previously known as adult-acquired flatfoot deformity,…
Charcot arthropathy is characterized by a destructive process that affects the bones, joints, and soft tissues of the foot and/or ankle in patients with neuropathy.
A weight bearing CT scan can:
- Assist in early detection and aid in an informed plan for early intervention, reducing complication risks1.
- Be used to monitor progression of deformity and help determine appropriate stage in which to surgically intervene, with the goal of preventing ulceration and infection.
- Provide insight into sites of instability.
- Determine areas of bony prominence that may lead to ulceration.
A WBCT scan provide valuable information regarding sites of Charcot arthropathy. Additionally, in the early stages of Charcot (Eichenholtz stages 0 and 1), a WBCT scan at regular intervals may be used to track progression and instability of the disease process.
Cone Beam CT
WBCT can be used to determine places of instability throughout the foot and ankle, which may help to guide surgical reconstruction. Additionally, WBCT scans can provide information about the size and quality of remaining bone stock in the foot. WBCT scans also can identify sites of bony prominence to plan exostectomies and prevent ulceration.
WBCT can improve surgical indications by better evaluating the severity of midfoot collapse, which has been shown to be associated with ulceration2.
For postoperative assessment of operative treatment of Charcot arthropathy, WBCT can:
- Accurately assess bony bridging across fusion sites3.
- Provide a three-dimensional analysis of deformity correction.
- Help to understand additional sites of collapse or instability.
Progression of Deformity
Due to uncertainty regarding instability and position of the talus, a WBCT scan was obtained. The WBCT demonstrated lateral subluxation of the calcaneus under the talus. It also demonstrated bone loss and the position of the talonavicular joint. The WBCT suggested that the tibiotalar joint was salvageable.
midfoot nail to stabilize the medial column and talonavicular joint, a beam across the subalar joint, and a beam from the calcaneus into the midfoot.
(1) Wukich DK, Sung W, Wipf SA, Armstrong DG. The consequences of complacency: managing the effects of unrecognized Charcot feet. Diabet Med. 2011 Feb;28(2):195-8. doi: 10.1111/j.1464-5491.2010.03141.x. PMID: 21219429.
(2) Radiographic Analysis of Diabetic Midfoot Charcot Neuroarthropathy With and Without Midfoot Ulceration. Dane K. Wukich, MD1,2, Katherine M. Raspovic, DPM3, Kimberlee B. Hobizal, DPM2, and Bedda Rosario, PhD4. Foot and Ankle International. 2014. November 35(11): 1108-1115.
(3) Armstrong, A. V. (2016, October). Current Concepts With Weightbearing CT. Hmpgloballearningnetwork.com. Retrieved March 30, 2023, from https://www.hmpgloballearningnetwork.com/site/podiatry/current-concepts-weightbearing-ct