A comprehensive narrative review of Charcot neuroarthropathy of the foot and ankle in diabetic patients, covering pathophysiology, the Eichenholtz and Brodsky classification systems, imaging strategies for distinguishing infection from Charcot changes, and the full spectrum of nonsurgical and surgical management options.
When you see a warm, swollen foot in a diabetic patient with neuropathy — even with normal radiographs — treat it as stage 0 Charcot until proven otherwise: offload immediately with a total contact cast and follow serially, because delayed treatment is hypothesized to drive catastrophic deformity.
Reserve surgery for recurrent ulceration over unbraceable deformity, acute instability, or infection refractory to casting, and counsel patients that complication rates are high and most evidence is level IV.
A comprehensive narrative review of Charcot neuroarthropathy of the foot and ankle in diabetic patients, covering pathophysiology, the Eichenholtz and Brodsky classification systems, imaging strategies for distinguishing infection from Charcot changes, and the full spectrum of nonsurgical and surgical management options.
When you see a warm, swollen foot in a diabetic patient with neuropathy — even with normal radiographs — treat it as stage 0 Charcot until proven otherwise: offload immediately with a total contact cast and follow serially, because delayed treatment is hypothesized to drive catastrophic deformity.
Reserve surgery for recurrent ulceration over unbraceable deformity, acute instability, or infection refractory to casting, and counsel patients that complication rates are high and most evidence is level IV.