The Charcot foot in diabetes

Abstract

The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity.

Figure 1

The typical appearance of a later-stage Charcot foot with a rocker-bottom deformity.

Figure 2

Lateral X-ray of a Charcot foot deformity showing a dislocation of the tarsometatarsal joint with break in the talo-first metatarsal line (dashed lines) and a reduced calcaneal inclination angle (solid lines).

Figure 3

An algorithm depicting the basic approach to the Charcot foot. *Osteomyelitis can be difficult to distinguish from the Charcot foot. The reader is referred to the “Imaging of the Charcot foot” section of the article for techniques to improve specificity of various imaging modalities.