Feature Article

Charcot’s neuroarthropathy: when a timely diagnosis matters

Georgina Frank, Thyra Bolton, Stephen M Twigg



Charcot’s neuroarthropathy is a diabetes complication that is important to recognise in order to prevent onset or progression of foot deformity. Patients with suspected Charcot’s neuroarthropathy require urgent referral to a specialist high-risk foot service for intensive management.

Key Points

  • Charcot’s neuroarthropathy (CN) is an uncommon complication of diabetes requiring a timely diagnosis to prevent foot deformity and optimise outcomes.
  • The diagnosis of CN relies mainly on clinical features, combined with targeted imaging such as plain x-rays and sometimes MRI.
  • CN pathogenesis remains unclear, with marked foot inflammatory changes in the early phases, usually on a background of dense peripheral neuropathy.
  • Immediate treatment involves avoidance of weight bearing and urgent referral to a specialist high-risk foot service, usually for total contact casting.
  • Management of chronic CN usually requires custom-made footwear and orthotics; plantar osteotomy may have a role to prevent recurrent ulceration.

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