A 56 year old Type II diabetic presents with complaints of swelling in the left ankle with effusion but only minimal pain. X-rays show severe osteopenia with bone destruction, extensive osteophytosis and loose bodies. The management of this patient includes all the following except:: (A) Resting and Splinting, (B) Aspiration and Compression bandage, (C) Total Ankle Replacement, (D) Ankle ahrodesis
Answer is C. Swelling in the ankle with effusion, minimal pain together with the given x-ray findings suggests the diagnosis of neuropathic joint disease or charcot's joint. Total ankle replacement is an absolute contraindication in the management of charcot's joint. Ref: Total Ankle Ahroplasty By Hintermann, 2005, Page 92; Apley's System of Ohopaedics and Fractures By Louis Solomon, 9th Edition, Chapter 5, Pages 98, 99