What is Charcot foot and how does it affect diabetics with peripheral neuropathy?

What is Charcot Foot?

Charcot foot is a destructive inflammatory condition that occurs in people with nerve damage (peripheral neuropathy), most commonly from diabetes, where the bones and joints of the foot progressively break down and collapse because the person cannot feel the injury happening. 1

How It Develops

• The condition starts when someone with neuropathy (loss of feeling in their feet) experiences trauma or injury to their foot, but because they can't feel pain, they keep walking on it 1, 2
• This triggers an excessive inflammatory response that activates bone-destroying cells (osteoclasts), causing bones to weaken and break down 3, 4
• The combination of weak bones and continued walking leads to fractures, joint dislocations, and eventual collapse of the foot's normal architecture 1, 2
• The foot shape becomes distorted—often developing a "flat foot" or "rocker-bottom" deformity—which creates abnormal pressure points that can lead to ulcers and infections 5, 1

What It Looks Like

• The hallmark presentation is a red, hot, swollen foot that may or may not have broken skin 1, 6
• The affected foot is noticeably warmer than the other foot (you can feel the temperature difference) 1, 6
• Surprisingly, pain is typically NOT a prominent symptom because the underlying nerve damage prevents the person from feeling it 2
• This lack of pain is precisely why the condition is so dangerous—people continue walking on a foot that is literally breaking apart 7

Who Gets It

• Approximately 0.3% of people with diabetes develop Charcot foot, representing about 1.6 million people worldwide 1, 3
• It occurs primarily in diabetics with peripheral neuropathy, though anyone with nerve damage from any cause can develop it 1, 6

Why It's Dangerous

• If untreated, the progressive deformity leads to foot ulcers, which can become infected 1, 7
• People with Charcot foot have a 6-12 times increased risk of major amputation 1
• The 5-year mortality rate is 29%, reflecting the severity of complications 1
• The condition is frequently misdiagnosed as infection, gout, or regular arthritis, leading to delayed treatment and worse outcomes 5, 7

The Critical Treatment

• The moment Charcot foot is suspected, the foot must be immediately immobilized in a non-removable total contact cast that extends to the knee—do not wait for imaging confirmation 1, 6
• This complete offloading (taking all weight off the foot) is the only way to stop the bone destruction process 1
• The cast must be non-removable because patients will otherwise walk on it, continuing the damage 1
• Treatment continues until the inflammation resolves, which can take months 1

Common Pitfall

• The biggest mistake is dismissing a red, hot, swollen foot in a diabetic with neuropathy as "just an infection" without considering Charcot foot 5, 7
• Even if infection is present, Charcot foot can coexist and must still be considered and treated 5
• Delayed diagnosis allows irreversible foot destruction to occur 7, 8