Challenges of Charcot Reconstruction Surgery

Article by Dr. Misako McLeod, DPM 

I’m one of the few foot and ankle surgeons in Hawaii who perform Charcot Foot and Ankle reconstructive surgery. Let me tell you, its not easy dealing with insurances, hospitals. anesthesia groups, and


Last year, I was calle dinto a Me

I toght to myself”this must be the one who

A pit bull of a nurse looked at lmd strigh tin the eye and


Most doctors DO NOT take on these surgeries for several reasons:

1. They are difficult, complex surgeries with severe issues and high risk for complications and non-compliant patients.

2. Nobody seems to understand what its about. There is little public knowledge on Charcot foot. Often times, I see a severe non-neurpathic foot with nora anatomy being labeled as as “Cahrcot foot” simply because it loos collapsed. This is a serious midusndetsanding of the diease process.


Charcot foot was first described by Jacque _______. in the France, the misery of the______




3. The hospitals dislike surgeries because their not a simple one-hour surgery that maxmizeds financial return. Its much moreprofiatble to a hospital to have your leg amputated than have several limb salvage suegrries,


4, The surgeries require long OR times and expensive implants and equipment.


5. It is usual an common that a patient will often thane to ben taken back to the OR to have their frame readjusted, tightened, or worse re-redirected you rewire.


5. Patients typically are noncompliant and lack understanding of the degree of


6. PAtients gets frustrated. arterials and lack of blod flow, open wounds, bad lungs, bad bone; smoking

In this world, we want to have things died and fixed quickly, unfortunately, mother nature doesn’t agree with this and will raise her wrath upon anyone who demands otherwise,

1. arteial – no


2. smoking and bone

3. bad lungs.


6. Patients are sick


7. Its not profitable


Why the insurance companies don’t like it:

1. Its expensive. It’s cheeper to cut off the patient’s leg than to perform a Charcot reconstructive surgery.



Why the hospitals don’t like you as a surgeon?

1. They don’t understand what you’re doing. Doesn’t matter that you save most of your patients form a below-knee-ampuation. That downs tmatter. Instead, they hire one year trained (thats ess than internship) to evaluate your most compacted case that they likely have never even seen or reform. When you ask for their case laid tonsure that they in fact are experienced and perform on a ruglr basis these toy e complex cases.




Its unfortunate that medicine has digressed to define itself merely by financial measures, and employing nonclinical bean counters wh lack understanding of the

I have always respected and admired the true interdisciplinary approach to medicine where doctors crate a think-tank and evaluate each patient as as individual – for all their persanol challenges, socioeconomic,a nd as wells the technical challenges of surgery.


Medicine is a a challengin uniue field that should deb entered for the . They will always be unites surgical cases and – these need to be and learned form to better educate the medical. What is happening is that




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