Successful Realignment Arthrodesis using a Superconstruct Technique and Adjuvant Denosumab in Severe Midfoot Charcot Neuroarthropathy: A Case Report

Charcot neuroarthropathy (CN) is characterized by a local inflammatory cascade with elevated cytokines (e.g., TNF-, IL-1, IL-6) and up-regulation of the RANKL-RANK-OPG pathway, which drive excessive osteoclastogenesis and accelerated bone resorption triggered by peripheral neuropathy and repetitive micro-trauma. [1][2]][3] As a result, CN in patients with diabetic neuropathy is a progressive and destructive joint disease leading to severe deformity, instability, and significant functional impairment. 1) Midfoot involvement frequently results in a "rocker-bottom" deformity from the collapse of the longitudinal arch, which complicates bracing and often leads to recurrent ulceration and infection. 4)For patients with severe deformities refractory to conservative treatment, the primary goal of surgery is to establish a stable, plantigrade, and braceable foot, thereby restoring functional