{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:03:19Z","timestamp":1781006599085,"version":"3.54.1"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Septic Charcot neuroarthropathy is a limb- and life-threatening condition characterized by the coexistence of neuropathic joint destruction and infection. In patients with severe systemic compromise, major amputation is often considered inevitable. Case Presentation: A 47-year-old man with untreated diabetes mellitus presented with progressive painless swelling of the left foot. He had morbid obesity (120 kg, 165 cm; body mass index 44.1 kg\/m2), severe hypoalbuminemia, and chronic kidney disease associated with nephrotic syndrome. Laboratory tests showed marked inflammation and poor glycemic control, and blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). Radiographs and computed tomography demonstrated destructive changes involving the talonavicular and subtalar joints, consistent with septic Charcot neuroarthropathy involving the midfoot. Because of sepsis, pulmonary edema, and heart failure, below-knee amputation was proposed at the referring hospital. However, limb salvage was attempted using aggressive debridement, continuous local antibiotic perfusion (CLAP; gentamicin 1200 \u03bcg\/mL) administered for 14 days, and temporary circular external fixation. Serum gentamicin concentrations and renal function were regularly monitored to ensure systemic safety and avoid nephrotoxicity. Results: Repeat irrigation and final debridement were performed 20 days after the index surgery, at which time the external fixator was removed and intraoperative cultures were negative. The patient was discharged 2 months after surgery without evidence of recurrent infection. At 4-year follow-up, no recurrence had occurred, and the patient was able to walk independently. Conclusions: Limb salvage may be feasible even in severely compromised patients with septic Charcot midfoot and MRSA bacteremia when aggressive debridement, CLAP, and temporary external fixation are combined with careful systemic safety monitoring. This case suggests that limb salvage may be considered in selected high-risk patients, although further studies are required.<\/jats:p>","DOI":"10.3390\/clinpract16060108","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T09:46:54Z","timestamp":1780998414000},"page":"108","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful Limb Salvage in MRSA Bacteremic Septic Charcot Midfoot Using Continuous Local Antibiotic Perfusion and Circular External Fixation: A Case Report"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0238-8929","authenticated-orcid":false,"given":"Koji","family":"Nozaka","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5175-3350","authenticated-orcid":false,"given":"Naohisa","family":"Miyakoshi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"114","DOI":"10.17161\/kjm.v11i4.8709","article-title":"Initial diagnosis and management for acute Charcot neuroarthropathy","volume":"11","author":"Vopat","year":"2018","journal-title":"Kans. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3207043","DOI":"10.1155\/2016\/3207043","article-title":"Charcot neuropathic arthropathy of the foot: A literature review and single-center experience","volume":"2016","author":"Kucera","year":"2016","journal-title":"J. Diabetes Res."},{"key":"ref_3","first-page":"100239","article-title":"An overview of Charcot\u2019s neuroarthropathy","volume":"22","author":"Dardari","year":"2020","journal-title":"J. Clin. Transl. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"21361","DOI":"10.3402\/dfa.v4i0.21361","article-title":"Charcot foot and ankle with osteomyelitis","volume":"4","author":"Donegan","year":"2013","journal-title":"Diabet. Foot Ankle"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1111\/j.1464-5491.2005.01677.x","article-title":"The perils of procrastination: Effects of early vs. delayed detection and treatment of incipient Charcot fracture","volume":"22","author":"Chantelau","year":"2005","journal-title":"Diabet. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/j.1464-5491.2010.03141.x","article-title":"The consequences of complacency: Managing the effects of unrecognized Charcot feet","volume":"28","author":"Wukich","year":"2011","journal-title":"Diabet. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1177\/1071100716649173","article-title":"Correlation of systemic inflammatory markers with radiographic stages of Charcot osteoarthropathy","volume":"37","author":"Hingsammer","year":"2016","journal-title":"Foot Ankle Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e3687","DOI":"10.1002\/dmrr.3687","article-title":"IWGDF\/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF\/IDSA 2023)","volume":"40","author":"Senneville","year":"2024","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1093\/cid\/cis346","article-title":"2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.3113\/FAI.2009.1065","article-title":"Limb salvage in Charcot foot and ankle osteomyelitis: Combined use of single stage\/double stage of arthrodesis and external fixation","volume":"30","author":"Brocco","year":"2009","journal-title":"Foot Ankle Int."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Berli, M., Vlachopoulos, L., Leupi, S., B\u00f6ni, T., and Baltin, C. (2017). Treatment of Charcot neuroarthropathy and osteomyelitis of the same foot: A retrospective cohort study. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1818-4"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.12968\/jowc.2020.29.Sup6.S19","article-title":"Surgical treatment of midfoot Charcot neuroarthropathy with osteomyelitis in patients with diabetes: A systematic review","volume":"29","author":"Ramanujam","year":"2020","journal-title":"J. Wound Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"961","DOI":"10.3113\/FAI.2007.0961","article-title":"Neutral ring fixation for high-risk nonplantigrade Charcot midfoot deformity","volume":"28","author":"Pinzur","year":"2007","journal-title":"Foot Ankle Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jcot.2021.02.016","article-title":"The use of circular frame external fixation in the treatment of ankle\/hindfoot Charcot neuroarthropathy","volume":"16","author":"Martin","year":"2021","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.jcot.2020.03.025","article-title":"Charcot foot reconstruction outcomes: A systematic review","volume":"11","author":"Ha","year":"2020","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102330","DOI":"10.1016\/j.jcot.2023.102330","article-title":"Investigation and management of diabetic foot osteomyelitis: An update for the foot and ankle orthopaedic surgeon","volume":"48","author":"Alkhalfan","year":"2024","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000351813","article-title":"Chronic kidney disease and the foot in diabetes\u2014Is inflammation the missing link?","volume":"123","author":"Game","year":"2013","journal-title":"Nephron Clin. Pract."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.2337\/dc07-2244","article-title":"Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes","volume":"31","author":"Margolis","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1111\/ans.70194","article-title":"Mortality and major amputation in patients with diabetes-related foot ulcers and chronic renal disease","volume":"95","author":"Beaumont","year":"2025","journal-title":"ANZ J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.jos.2020.11.010","article-title":"A novel treatment strategy using continuous local antibiotic perfusion: A case series study of a refractory infection caused by hypervirulent Klebsiella pneumoniae","volume":"27","author":"Himeno","year":"2022","journal-title":"J. Orthop. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.jos.2024.07.011","article-title":"Continuous local antibiotic perfusion for deep infection of the foot and ankle","volume":"30","author":"Nakajima","year":"2025","journal-title":"J. Orthop. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1007\/s00125-008-1089-6","article-title":"Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study","volume":"51","author":"Prompers","year":"2008","journal-title":"Diabetologia"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1128\/JCM.37.6.1771-1776.1999","article-title":"The Calgary Biofilm Device: New technology for rapid determination of antibiotic susceptibilities of bacterial biofilms","volume":"37","author":"Ceri","year":"1999","journal-title":"J. Clin. Microbiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.2106\/JBJS.OA.25.00212","article-title":"Continuous local antibiotic perfusion: A novel technique for the treatment of orthopaedic infections: Narrative review","volume":"11","author":"Choe","year":"2026","journal-title":"JBJS Open Access"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Shimoda, M., Choe, H., Hieda, Y., Abe, K., Ike, H., Mitsui, H., Kono, H., Kumagai, K., Kobayashi, N., and Inaba, Y. (J. Orthop. Sci., 2026). Factors associated with elevated serum gentamicin levels in hip and knee joints treated with continuous local antibiotic perfusion: A retrospective cohort study, J. Orthop. Sci., in press.","DOI":"10.1016\/j.jos.2026.01.004"}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/6\/108\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:28:59Z","timestamp":1781004539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/6\/108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["clinpract16060108"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16060108","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]}}}