Tibiotalocalcaneal fusion in Charcot ankle arthropathy: Technical and biological considerations

Table 1 Stage-based management of Charcot neuroarthropathy

Stage	Clinical features	Main treatment
Stage 0	Warmth, swelling, subtle imaging changes	Immediate immobilization and offloading
Stage I	Fragmentation, active destruction	Non-removable knee-high offloading, close monitoring
Stage II	Coalescence	Protected progression, orthotic planning
Stage III	Consolidated deformity	Custom bracing or reconstruction if non-plantigrade/unstable

Table 2 Main fixation options for tibiotalocalcaneal fusion in Charcot hindfoot and ankle disease

Method	Advantages	Limitations
Retrograde intramedullary nail	Load sharing, spans ankle and subtalar joints, limited stripping	Implant failure, nonunion, infection
Plate fixation	Alignment control, useful when nailing unsuitable	Wider exposure, soft-tissue risk
External fixation	Useful in infection or poor soft tissue	Pin-related problems, patient burden
Hybrid fixation	Added stability in selected salvage cases	Complexity and limited evidence