Patellar tendon-bearing, patten-bottom caliper suspension orthosis in active Charcot arthropathy: crutch-free ambulation with no weight bearing in the foot

A custom, patellar-tendon bearing (PTB), patten-bottom, caliper suspension orthosis was constructed for six patients with severe, active (Eichenholtz stage I) Charcot arthropathy of the ankle and hindfoot. With the orthosis, the suspended foot and ankle remained completely non-weight-bearing, and the lower extremity supported full weight bearing along the posterior and anterior leg shells and PTB crest. Four of the six patients used the orthosis to ambulate without crutches, leaving the upper extremities free for functional use. Frequent adjustment of the orthosis and skin examination were required. Minor problems with the orthosis included superficial skin breakdown and downward pistoning of the leg associated with improper, loose donning. Patient compliance was poor in four of the six patients because of general debility, difficulty with balance, and discomfort. However, in the other two patients, the absence of mechanical forces on the foot and ankle in the orthosis allowed the swelling and erythema of the active phase of Charcot arthropathy to resolve within several weeks, with maintenance of functional ambulation during the months required for healing of the Charcot process.