Neuro-osteoarthropathy: The Charcot Foot—Pathology, Diagnosis, and Treatment

Abstract

New cases of Charcot foot are uncommon, but not so uncommon that the condition does not need to be considered by non-specialists. Once the diagnosis is considered, the person with a possible acute Charcot foot should avoid any weight-bearing on the affected foot and the condition should be assessed by an expert as soon as possible. The condition results from uncontrolled inflammation within the bones, joints and soft tissues of the foot and is likely to be mediated by a number of direct and indirect consequences of neuropathy. There is no specific treatment and management relies on the provision of effective off-loading to (1) splint the affected foot in order to curtail the process of inflammation and (2) protect the affected foot from the trauma of weight-bearing while the bones and joint are vulnerable. There is no agreement on the role of surgery in the active, inflammatory, phase and it should be adopted only by experienced experts in the field. When the active phase has entered remission, there may be a place for elective surgery to correct residual deformity. The person who has had a Charcot foot should remain under long-term review because of (1) the risk of secondary ulceration resulting from residual deformity, (2) the risk of contralateral disease and (3) to address the acknowledged reduction in long-term survival.