The Charcot Foot in Diabetes

The Charcot Foot, although not exclusive to diabetes, is indeed a major and life-changing lower extremity complication of the disease. A consequence of even subtle trauma to those persons with peripheral neuropathy, this devastating complication all too often leads to significant foot and ankle deformities that place the foot at high risk for ulceration, infection, gangrene, and potential limb loss. Fortunately, our understanding of the etiology and management of the Charcot foot has markedly improved since its first description in 1883. With improved recognition of the underlying pathophysiology and inflammatory underpinnings, our approaches to treatment have evolved as well. While rest, offloading, and immobilization remain the mainstays of treatment in the early, active stages, specific pharmacological interventions have not been proven effective in mitigating the course of the disease process. Nonetheless, we now also recognize the importance that surgical reconstruction plays in managing chronic deformities or instability in preserving a functional foot and limb. Affecting literally hundreds of thousands of persons with diabetes in the United States alone, the Charcot foot is no longer considered to be a rare complication of the disease. Indeed, the last several decades have seen a literal explosion of reports of Charcot foot incidence and management strategies from every corner of the Globe. Most importantly, with the improved understanding of this entity, we now recognize that a high index of suspicion in persons at risk is critical for making the diagnosis early—and thereby preventing those limb-threatening deformities resulting from delayed diagnosis and management.