Radiographic Evaluation of Charcot Foot Involving the Lateral Column

Review Article

Foot Ankle Stud. 2021; 3(1): 1023.

Radiographic Evaluation of Charcot Foot Involving the Lateral Column

Hale T and Bennett J*

College of Podiatric Medicine and Surgery, Des Moines University, USA

*Corresponding author: Bennett J, College of Podiatric Medicine and Surgery, Des Moines University, 3200 Grand Ave, DesMoines, IA 50312, USA

Received: May 11, 2021; Accepted: May 31, 2021; Published: June 07, 2021


In the study of Charcot foot, the lateral column has been largely neglected in previous research. The purpose of the current study is to radiographically characterize the lateral column in Charcot midfoot collapse.

Keywords: Charcot; Lateral column; Radiology; Cuboid height


Charcot foot deformities are a difficult, malignant complication of peripheral neuropathy. Although “rocker bottom” feet were originally described in patients with syphilis [1], today’s Charcot deformities are mostly due to diabetic neuropathy [2] combined with trauma to the foot.

Numerous surgical and non-surgical treatments are available, and should aim to reduce risk of complications or amputation in the future, and ideally, surgically create a plantigrade, biomechanically stable foot [3].

Outcomes without adequate treatment include diabetic ulcers, osteomyelitis, amputation, permanent disability, and lower patient quality of life. Literature review predicts five-year mortality rates after initial ulceration to be 40% [4], and any type of lower limb amputation five-year mortality to be 53-100 % [5].

In his 1966 book, Eichenholtz postulated that the reflex muscle spasm following a fracture, without reduction, would cause angulations and/or overriding of the bones involved, leading to misunion in the healing process [6]. Literature has proposed that Charcot is a result of demineralized bone and weakened ligaments [7]. Grant and colleagues showed that patients with midfoot dislocations had near normal central bone density, and increased regional bone density. They concluded that the midfoot dislocation “may signify an aberration of capsule/tendon, which is unable to withstand the bending moments of gait and thus resulting in dislocation” [8]. Furthermore, the authors of the current study hypothesize that midfoot Charcot deformity is characterized by ligamentous failure.

When considering a surgical Charcot reconstruction, the medial column has been well studied and emphasized, such as the relationship between the 1st metatarsal and talus, otherwise known as Meary’s angle. This 0-degree angle is used to measure outcomes of numerous studies and surgical procedures. However, such characterization of the lateral column has not been as well studied in previous research. Previous research has shown that a positive correlation exists between cuboid height and calcaneal-fifth metatarsal angle [9]. Additionally, patients with Charcot neuropathy and ulcers exhibit significantly greater deformity in respects to calcaneal-fifth metatarsal angle and lateral column involvement than their non-ulcer counterparts [10]. Therefore, characterization of the “ideal”ith syphilis [1] lateral column is imperative to significantly improving patient outcomes.

The aim of the current study is to radiographically characterize the lateral column in Charcot midfoot collapse.


Patients were identified using ICD-10 codes through the DMU Foot and Ankle Clinic records (M14672 and M14671). Lateral radiographs were deidentified and presented to an experienced, third party podiatrist to measure. Angles of interest were Calcaneal Inclination Angle (CIA), Critical Angle of Gissane (CAG), Bohler’s Angle (BA), and a Calcaneal-5th metatarsal bisection angle (C5th). Additionally, the authors were interested in the distance that the cuboid falls below the horizontal line between the lowest aspect of the calcaneus and 5th metatarsal head, hereafter referred to as “Cuboid Height” (CH).

Furthermore, x-rays were visually inspected to determine lateral column involvement, cuboid plantarflexion, and forefoot subluxation over the tarsals. Radiographic angles and qualitative observations were then correlated with ulceration presence and location.


Six patients were excluded due to poor visualization, or too extensive of destruction to measure angles accurately, leaving 47 patients and 50 feet to be analyzed. 18 participants were female (38.3%) and 29 males (61.7%). Average age was 60.8 years old at the time of data collection, with a range of 43-84 years old, and with four patients confirmed deceased at the time of the current study.

Radiographically, the lateral column was involved in 27/50 feet (54%), cuboid plantarflexion was seen in 28/50 (56%), and forefoot subluxation in 17/50 feet (34%).

Of the 50 feet analyzed, ulcerations occurred in 31 feet (62%), with two feet studied having multiple ulcerations, further described in Table 1. Mean, standard deviation, and range of the measurements previously described are outlined in Table 2 for all patients, those with or without ulceration, lateral ulcerations, medial ulcerations, as well as a comparison to the previously described accepted normal ranges of these measurements.