Reconstruction Using a Free Anterolateral Thigh Flap for the Treatment of Rocker-Bottom Deformity and Ulcer Associated with Diabetic Charcot Foot

Abstract

In Charcot foot deformity caused by diabetes, the tarsal bones undergo pathological fractures due to diabetic neuropathy, resulting in a protruding plantar surface deformity known as a rocker-bottom deformity. Ulcer formation on the bony prominences is difficult to heal and often leads to major amputation. In this study, we performed ostectomy of the protruding bones and closure with a free anterolateral thigh flap for two patients with plantar ulcers associated with Charcot foot deformity. The flaps survived in all cases and long-term ulcer-free healing was achieved with the use of offloading devices. While arthrodesis is considered the primary treatment for deformed joints, it may be challenging to perform in cases with significant ulceration and exposed bone. Closure with a flap is considered a viable option in such cases. Charcot foot deformity in diabetes can continue to progress during the course of treatment. Therefore, the continued use of offloading devices and regular adjustments, along with multidisciplinary support, are crucial.

Appearance at eleven years postoperatively.