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HEALTHCARE ADVOCATES, INDUSTRY LEADERS With more than 40 years of experience, our Healthcare Section offers Healthcare Representation & Counseling, Coding Review and Staff Training. We make it possible for you to focus on patient care, while we tackle the legal obstacles you are faced with on an ongoing basis. WE ARE THE HEALTHCARE SECTION OF KRUGLIAK, WILKINS, GRIFFITHS & DOUGHERTY, CO., L.P.A. 4775 Munson Street N.W. | P.O. Box 36963 | Canton, Ohio 44735 | 330-497-0700 | Fax 330-497-4020 John M. Tucker • Randall C. Hunt • Fred J. Haupt Jason F. Haupt • Laura A. Brady Offices in Canton, Akron, Alliance, New Philadelphia & Sugarcreek KWGD.com C HARCOT NEUROARTHROPATHY (CN) can be a devastat- ing condition affecting the insensate foot. Progressive neuropathy-driven fractures and joint dislocations can lead to an unbraceable structural collapse of the foot and eventual skin breakdown. The pathway that often follows includes deep extension of ulceration, osteomyelitis and limb loss. In fact, CN rapidly escalates the limb-loss potential in the diabetic neuropathic population when it occurs. Early recognition of the CN cascade followed by external protec- tion of the limb has been shown to quiet the CN process and thereby avoid bony injury and collapse in many diabetic neuropathic patients in this author's practice. Inevitably, however, feet that have already undergone the fracture-dislocation process walk (yes, unfortunately…walk) into the practices of podiatric surgeons. These are the feet that, when an intact soft-tissue envelope is in place, present a unique opportunity for the surgeon to go beyond timely external protection of the limb and provide significant internal bony stabiliza- tion via arthrodesis (joint fusion). Joint fusion has traditionally required large incisions for adequate joint exposure and placement of fixation. However, this is a patient population in which large incisions are at high risk for dehiscence and, therefore, further complications. The percutaneous approach to joint preparation, following adequate deformity reduction, utilizes drill bits inserted through small incisions, is carried out under orthogonal fluoroscopic views, and allows for the articular cartilage removal and bone debridement necessary to encourage fusion (see Figure 1). Internal or external fixation can then be applied and maintained during the bone healing process. This minimally invasive approach provides an additional tool for surgical limb preservation in this challenging population. Dr. Jeffrey Whitaker is board certified by the American Board of Foot and Ankle Surgery and a Fellow of the American College of Foot and Ankle Surgeons. He is Division Head and Associate Professor of Podiatric Surgery at Kent State University College of Podiatric Medicine, in Independence, Ohio. ■ Percutaneous Approach to the Acute Charcot Foot By Jeffrey M. Whitaker, DPM, FACFAS 2 0 1 5 S E P T E M B E R /O C T O B E R ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 9