Arthrodesis and the Total-Contact Cast in Treatment of the Neuropathic Foot
Grace Warren, AM, MD, MS, FRCS, FRACS, DTM&H; Sheldon R. Simon, MD; Samir G. Tejwani, MD; Deborah L. Wilson, MD; Thomas J. Santner, PhD; Nancy L. Denniston, MS

To The Editor:

I read “Arthrodesis as an Early Alternative to Nonoperative Management of Charcot Arthropathy of the Diabetic Foot” (82‐A: 939‐50, July 2000), by Simon et al., with interest. I offer my congratulations to the authors, who have taken such care to produce evidence, from their study of fourteen patients, that a carefully and correctly performed arthrodesis of neuropathically damaged bone should result in stable healed bone and satisfactory function, if the foot is adequately immobilized. My hope is that their results will inspire others to reconstruct deformed neuropathic feet.

In 1964, I performed my first arthrodesis to treat a totally neuropathic foot, deformed because of continued unprotected weight‐bearing by bones decalcified due to chronic infection. There was microtrauma that had led to impaction of the mid‐tarsal joints and collapse of the medial arch, and the foot was in danger of ulceration of both the skin and deeper tissues. Radiographs made preoperatively and both radiographs and photographs made at the twenty-year follow-up showed that such treatment measures can be successful and long-lasting1. Since that first operation, I have performed over a thousand arthrodeses to reduce the disability caused by bone disintegration in patients with neuropathy from many causes including diabetes, which is the principal cause in developed societies. I have found that the required duration of immobilization depends on the site of the lesion and on the amount of stress that the healed bone must bear. The immobilization time required after both nonsurgical and surgical treatment is similar, because it must allow for adequate recalcification of the newly healed bone so that unprotected weight-bearing in a limb with reduced pain perception will not result in further …

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