Charcot neuroarthropathy (CN) of the foot can lead to severe foot deformity, increased plantar pressures, and ulcer formation. Surgical reconstruction is challenging due to the complex 3D nature of the deformity. Conventional freehand reconstruction based on visual assessment and 2D fluoroscopy may result in suboptimal correction. To address the 3D nature off the foot, this paper presents a novel 3D virtual surgical planning (VSP) and patient specific guide (PSG) applied to a single patient with CN to assess technical feasibility.

For one patient with CN, a 3D foot model was created from a preoperative CT-scan. A VSP was developed by defining target foot alignment using clinical 3D reference angles and surgical expertise. Patient-specific osteotomy and reposition guides were designed to execute the planned closing wedge osteotomy and align the foot according to the VSP. Postoperative alignment was assessed by comparing the VSP with a 3D model of the peroperative CT-scan.

Creation of the VSP and PSG required approximately 210 minutes. The osteotomy guide fitted the bones as intended and guided osteotomy. Fluoroscopy confirmed K-wire placement according to the planned trajectory, and the reposition guide enabled alignment of the distal foot part. Postoperative 3D angle analysis demonstrated correction towards the VSP, with differences ranging from 2.3° to 10.3°.

This paper demonstrates the feasibility of a novel 3D VSP and PSG for Charcot midfoot reconstruction. Further optimization of guide design is required to improve correction accuracy and stability during repositioning. Larger studies are needed to determine its clinical value.