{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:51:48Z","timestamp":1791345108077,"version":"4.3.1"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":90,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advanced Charcot neuro-osteoarthropathy involving the hindfoot is associated with severe deformity, instability, ulceration, infection, and major lower-limb amputation. Non-traumatic calcaneal fracture associated with diabetic Charcot hindfoot collapse is uncommon and difficult to treat because of neuropathy, impaired bone quality, tendon imbalance, soft tissue compromise, and a high risk of fixation failure. Reports describing long-term functional limb preservation in patients with advanced Charcot hindfoot collapse associated with severe metabolic bone impairment remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 63-year-old Japanese woman with a 36-year history of type 1 diabetes mellitus presented with progressive right hindfoot deformity and ulceration without major trauma. Radiographs and computed tomography demonstrated advanced Charcot hindfoot collapse with a non-traumatic calcaneal fracture classified as Eichenholtz stage III and Brodsky type 3B. Preoperative evaluation demonstrated severe vitamin D deficiency and elevated bone turnover markers. The patient underwent corrective osteotomy of the calcaneus, Achilles tendon Z-lengthening, internal fixation with headless compression screws, autologous iliac bone grafting, and circular external fixation. A staged postoperative unloading protocol was used, followed by gradual protected loading. Sequential metabolic therapy was administered after surgery. Bone union was achieved at approximately 3 months, and the external fixator was removed at 3.5 months. During long-term follow-up, glycaemic control and bone mineral density improved. At 8 years after surgery, the patient remained ambulatory with preserved plantigrade alignment and without recurrent ulceration, infection, fixation failure, or amputation. The American Orthopaedic Foot &amp; Ankle Society ankle-hindfoot score was 94. Interpretation of pain scores was limited by profound diabetic neuropathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case illustrates an integrated multidisciplinary limb-salvage strategy combining mechanical reconstruction, staged postoperative offloading, and metabolic optimisation in a patient with advanced diabetic Charcot hindfoot deformity complicated by severe metabolic bone impairment. The favourable long-term outcome should be interpreted as hypothesis-generating rather than evidence for the efficacy of any individual adjunctive therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12891-026-10193-5","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T03:26:09Z","timestamp":1783567569000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated mechanical and metabolic limb salvage for advanced diabetic Charcot hindfoot collapse with non-traumatic calcaneal fracture: an 8-year follow-up case report"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0238-8929","authenticated-orcid":false,"given":"Koji","family":"Nozaka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Aonuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Tominaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naohisa","family":"Miyakoshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"issue":"Suppl 1","key":"10193_CR1","doi-asserted-by":"publisher","first-page":"S58","DOI":"10.1002\/dmrr.846","volume":"24","author":"NL Petrova","year":"2008","unstructured":"Petrova NL, Edmonds ME. 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