Charcot Neuroarthropathy of the Foot and Ankle: Symptoms, Causes, and Treatment

Charcot neuroarthropathy — often called Charcot foot — is a serious and potentially limb-threatening condition that affects people with peripheral neuropathy, most commonly those with diabetes.

Charcot foot can cause progressive bone weakening, fractures, joint collapse, and severe deformity if not diagnosed early. Because it often begins with mild swelling and redness rather than severe pain, it is frequently misdiagnosed or overlooked.

Early recognition is critical.

What Is Charcot Neuroarthropathy?

Charcot neuroarthropathy is a condition in which weakened bones in the foot or ankle fracture and collapse due to underlying nerve damage (neuropathy).

When sensation is reduced, small injuries may go unnoticed. Continued walking on an injured foot can lead to:

Joint dislocation
Bone fragmentation
Arch collapse
Rocker-bottom deformity
Severe instability

Without treatment, Charcot foot can significantly increase the risk of ulceration and amputation.

What Causes Charcot Foot?

The primary underlying cause is peripheral neuropathy, most commonly due to diabetes. Other causes may include:

Long-standing diabetes with nerve damage
Spinal cord injury
Alcohol-related neuropathy
Other neurological disorders

Neuropathy reduces protective sensation, meaning patients may not feel fractures or joint damage as it occurs.

Early Signs and Symptoms of Charcot Neuroarthropathy

Charcot foot often begins subtly. Early symptoms may include:

Swelling in one foot or ankle
Warmth compared to the opposite foot
Redness
Mild discomfort (or surprisingly little pain)
Foot shape changes over time

A key warning sign is a swollen, warm foot in a patient with neuropathy — even without injury.

Because symptoms resemble infection, gout, or a sprain, proper evaluation is essential.

Stages of Charcot Foot

Charcot neuroarthropathy progresses in stages:

Acute (Fragmentation Stage)

Active inflammation
Bone weakening and fractures
Significant swelling and warmth

Coalescence Stage

Decreased inflammation
Early healing and bone resorption

Consolidation Stage

Bones stabilize
Permanent deformity may remain

Early intervention during the acute phase offers the best outcomes.

How Is Charcot Neuroarthropathy Diagnosed?

Diagnosis involves:

Thorough clinical evaluation
Comparison of skin temperature between the feet
X-rays to assess fractures and joint alignment
Advanced imaging if early changes are not visible

Prompt diagnosis can prevent permanent deformity.

Treatment of Charcot Neuroarthropathy

Treatment focuses on protecting the foot, preventing collapse, and reducing complications.

Immediate Offloading

The most important step in early Charcot foot treatment is complete immobilization and offloading.

This may include:

Total contact casting
Controlled ankle motion (CAM) boot
Strict non-weight-bearing

Continued walking on the foot during the acute stage can worsen deformity.

Custom Bracing and Long-Term Protection

After the acute phase resolves, patients often require:

Custom orthotics
Diabetic footwear
Bracing for stability

These help prevent recurrence and ulcer formation.

Surgical Intervention

Surgery may be necessary if:

Severe deformity develops
Ulceration occurs due to a bony prominence
Instability prevents safe walking

Surgical reconstruction can restore alignment and reduce ulcer risk, but it is typically reserved for advanced cases.

Why Early Treatment Matters

Untreated Charcot neuroarthropathy can lead to:

Severe foot deformity
Chronic wounds
Infection
Increased risk of amputation

However, when identified early and properly managed, many patients maintain mobility and avoid major complications.

When to Seek Immediate Evaluation

Seek prompt evaluation if you have diabetes or neuropathy and notice:

A swollen, warm foot
Redness without injury
Sudden change in foot shape
Persistent swelling that does not improve

Protecting Your Foot Health

Patients with diabetes should perform daily foot checks and schedule regular podiatric evaluations, especially if neuropathy is present.

At Gentle Foot and Ankle Care, we evaluate and manage complex diabetic foot conditions, including Charcot neuroarthropathy. Early detection and structured treatment can significantly reduce the risk of long-term complications.

If you notice swelling or warmth in your foot, schedule an evaluation as soon as possible.