Time critical Charcot foot reconstructions can be safely performed in the absence of optimal preoperative glycaemic control when delivered by MDT
Ahmed, Vainieri, Manu, Hester, Kavarthapu · Foot & Ankle Surgery 2026;32(3):269–274A review of 18 consecutive planned Charcot reconstructions (8 midfoot, 2 hindfoot, 8 combined) with at least a year of follow-up. Guidelines suggest waiting until HbA1c is below 8.5%; seven of these patients did not reach that target and the team went ahead anyway. There were four complications, all settled without further surgery, and no kidney or heart complications. At one year 11 patients (61%) were walking in shoes, and results did not differ between those who met the target and those who did not.
doi.org/10.1016/j.fas.2025.10.001Investigation and management of diabetic foot osteomyelitis: an update for the foot and ankle orthopaedic surgeon
Alkhalfan, Lewis, Kavarthapu, Hester · Journal of Clinical Orthopaedics and Trauma 2024;48:102330A review of bone infection in the diabetic foot, written for surgeons. It covers diagnosis with MRI, bone scans and bone biopsy, culture-guided antibiotics often given for long periods, and surgery ranging from drainage to debridement and bone resection. It also sets out how recurrence is prevented: glucose control, foot care, patient education, restoring blood supply where needed, and early review of any new wound.
doi.org/10.1016/j.jcot.2023.102330Combined Charcot hindfoot and midfoot reconstruction using internal fixation: surgical technique and single-surgeon series
Kavarthapu, Guduri, Hester · Annals of Joint 2023;8:10Around a third of Charcot deformities needing limb salvage involve both the hindfoot and the midfoot. This paper describes the technique — hindfoot first, then midfoot, with long rigid internal fixation — in 34 patients (35 feet) treated between 2009 and 2019, eleven of them in two stages because of active infection. At a mean of 53 months, 11 of 13 ulcers had healed and 33 feet were fully weight-bearing in surgical shoes or a brace. Metalwork failed in five feet and four patients needed revision.
doi.org/10.21037/aoj-22-23Etiology, epidemiology and outcomes of managing Charcot arthropathy
Hester, Kavarthapu · Foot and Ankle Clinics 2022;27(3):583–594An invited review of what causes Charcot arthropathy, the factors that influence the outcome of treatment, and what the condition costs health systems. Surgery for Charcot is becoming more common, driven by rising prevalence, a better understanding of the cause, and better identification of the patient factors that can be improved before an operation.
doi.org/10.1016/j.fcl.2022.03.002Predictors of metalwork failure and non-union after hindfoot Charcot reconstruction
Najefi, Zaidi, Chan, Hester, Kavarthapu · Bone & Joint Journal 2022;104-B(6):703–708Seventy hindfoot reconstructions with an intramedullary nail between 2007 and 2019, followed for a mean of 54 months. The hindfoot fused in 83% and 74% were fully weight-bearing at final review. Age, weight, HbA1c and previous vascular surgery made no difference to union. What did: a nail that filled the tibial canal, an additional hindfoot compression screw (95% union against 78%), and an intact medial malleolus. Metalwork failed in 19%. These findings shape how the construct is built.
doi.org/10.1302/0301-620X.104B6.BJJ-2022-0127Charcot hindfoot deformity reconstruction using a hindfoot nail: surgical technique
Kavarthapu, Hester · Journal of Clinical Orthopaedics and Trauma 2021;16:277–284A step-by-step account of the operation for the collapsed Charcot ankle and hindfoot: assessment, planning and timing, the approaches and bone cuts, nail insertion and locking, and the additional screw or plate that adds rotational stability. It is written to shorten the learning curve for other surgeons.
doi.org/10.1016/j.jcot.2021.02.007Current concepts and challenges in managing ankle fractures in the presence of diabetes: a systematic review
Nash, Hester, Ha · Journal of Clinical Orthopaedics and Trauma 2021;17:44–53Forty studies reviewed. Complications after an ankle fracture are more common in diabetes, and more common again when diabetes is poorly controlled, insulin-dependent or complicated by neuropathy or vascular disease. Non-operative treatment did poorly. Supplementary fixation was associated with fewer complications. In stable fractures without neuropathy, early weight-bearing gave results similar to people without diabetes. External fixators as definitive treatment carried high complication rates.
doi.org/10.1016/j.jcot.2021.01.016Charcot foot reconstruction outcomes: a systematic review
Ha, Hester, Foley, Reichert, Vas, Ahluwalia, Kavarthapu · Journal of Clinical Orthopaedics and Trauma 2020;11(3):357–368Every published series of Charcot reconstruction from 1993 to 2018: 1,116 feet in 1,089 patients. Internal fixation was used in 65%, external fixation in 31% and both in 4%, with no technique clearly better than another. Overall bone fusion was 86%, a technique-related complication occurred in 36%, the amputation rate after reconstruction was 5.5% and 91% returned to walking. The authors note that the quality of the evidence is low.
doi.org/10.1016/j.jcot.2020.03.025Modern orthopaedic inpatient care of the orthopaedic patient with diabetic foot disease
Bateman, Bradford, Hester, Kubelka, Tremlett, Morris, Pendry, Kavarthapu, Edmonds · International Journal of Lower Extremity Wounds 2015;14(4):384–392A review of 30 admissions in 19 complex patients needing surgery for infected ulcers, Charcot deformity or both, managed by the multidisciplinary team as a series of key events with close microbiological and blood-test monitoring. There were three minor amputations and no major amputations. Podiatry swabs matched the surgical bone specimen in only two of nine pairs, which is the reason bone is sampled.
doi.org/10.1177/1534734615596114The medial column Synthes Midfoot Fusion Bolt is associated with unacceptable rates of failure in corrective fusion for Charcot deformity
Butt, Hester, Bilal, Edmonds, Kavarthapu · Bone & Joint Journal 2015;97-B(6):809–813The first nine patients (ten feet) in whom a single 6 mm bolt was used to fuse the inner column of the foot. The deformity was corrected well — the mean Meary angle improved from 26° to 1° — but in all but two feet at least one joint failed to fuse, the bolt migrated in six, and four needed revision, which then united. The device could not be recommended in that form; midfoot fixation moved to long beams and plates.
doi.org/10.1302/0301-620X.97B6.34844Outcome of one-stage correction of deformities of the ankle and hindfoot and fusion in Charcot neuroarthropathy using a retrograde intramedullary hindfoot arthrodesis nail
Siebachmeyer, Boddu, Bilal, Hester, Hardwick, Fox, Edmonds, Kavarthapu · Bone & Joint Journal 2015;97-B(1):76–82Twenty patients (21 feet) with severe ankle and hindfoot deformity, 15 of them with long-standing ulcers, treated with single-stage correction and a retrograde hindfoot nail. At a mean of 26 months every limb had been saved, 80% of ulcers had healed and all but one patient walked independently. One nail broke and was revised. Standard screws migrated where hydroxyapatite-coated screws did not. Function and quality-of-life scores improved significantly.
doi.org/10.1302/0301-620X.97B1.34542Plantar fascia calcification: a sequela of corticosteroid injection in the treatment of recalcitrant plantar fasciitis
Fox, Oliver, Wek, Hester · BMJ Case Reports 2013A case report. Two and a half years after a steroid injection for severe heel pain, a calcified lump under the skin ulcerated and became infected, leading to a diabetic foot infection that needed a long course of intravenous antibiotics.
doi.org/10.1136/bcr-2013-200303Time critical Charcot foot reconstructions can still be performed in the absence of preoperative glycemic control when delivered by MDT
Ahmed, Bakir, Hester, Manu, Vainieri, Kavarthapu · Foot & Ankle Orthopaedics 2024;9(4) — conference abstractThe conference abstract of the Foot & Ankle Surgery paper above, reporting the same group of 18 patients (10 with type 1 and 8 with type 2 diabetes) and the same conclusion.
doi.org/10.1177/2473011424S00561