Emara KM, Eissa MO. Tibiotalocalcaneal fusion in Charcot ankle arthropathy: Technical and biological considerations. World J Orthop 2026; 17(6): 119597 [DOI: 10.5312/wjo.v17.i6.119597]
Corresponding Author of This Article
Mohamed O Eissa, MD, Professor, Department of Orthopedic Surgery, Ain Shams University, Abbasia Square, Cairo 11591, Egypt. mohamed.eissa@med.asu.edu.eg
Research Domain of This Article
Orthopedics
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review-article
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World J Orthop. Jun 18, 2026; 17(6): 119597 Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.119597
Tibiotalocalcaneal fusion in Charcot ankle arthropathy: Technical and biological considerations
Khaled M Emara, Mohamed O Eissa
Khaled M Emara, Mohamed O Eissa, Department of Orthopedic Surgery, Ain Shams University, Cairo 11591, Egypt
Author contributions: Emara KM carried out study conception and critical revision, prepared figures and tables; Eissa MO carried out the literature review and prepared the manuscript draft, performed data collection and analysis; and all authors read and approved the final manuscript.
AI contribution statement: AI tools (specifically Grammarly) was used solely for grammar checking and language refinement. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Mohamed O Eissa, MD, Professor, Department of Orthopedic Surgery, Ain Shams University, Abbasia Square, Cairo 11591, Egypt. mohamed.eissa@med.asu.edu.eg
Received: February 2, 2026 Revised: February 23, 2026 Accepted: May 6, 2026 Published online: June 18, 2026 Processing time: 137 Days and 7.7 Hours
Abstract
Charcot neuroarthropathy is a progressive destructive arthropathy that most commonly affects the foot and ankle in the setting of peripheral neuropathy, particularly diabetic neuropathy. The disease is characterized by inflammation, osseous resorption, instability, deformity, ulceration, and an elevated risk of amputation if not diagnosed and treated early. Management is stage dependent and requires a combination of offloading, immobilization, metabolic optimization, orthotic support, and, in selected cases, surgery. While acute disease is treated primarily nonoperatively, chronic deformity and instability frequently necessitate reconstruction to achieve a stable, plantigrade, ulcer-free foot. Among reconstructive options, tibiotalocalcaneal fusion remains one of the most important procedures for severe hindfoot and ankle involvement. It offers a limb-salvage solution in patients with fixed deformity, recurrent ulceration, or failed conservative treatment. However, the procedure remains challenging because of poor bone quality, neuropathic overload, impaired healing, and high complication rates. Modern strategies emphasize the use of superconstruct principles, rigid fixation, biologic augmentation, and strict postoperative protection to improve union and functional outcome. This article discusses the current management of Charcot neuroarthropathy across the disease spectrum, with particular focus on the indications, techniques, outcomes, and complications of tibiotalocalcaneal fusion.
Core Tip: Charcot neuroarthropathy requires early diagnosis, strict offloading, and stage-specific treatment. Most acute cases are managed conservatively, but advanced hindfoot and ankle deformity often require tibiotalocalcaneal fusion. Success depends on rigid fixation, biological support, and careful postoperative protection.
