Charcot Neuroarthropathy
Charcot neuroarthropathy is a serious foot condition that develops in people with significant nerve damage, most often due to diabetes. Because the nerves no longer send normal pain signals, injuries such as fractures or joint damage can go unnoticed. Over time, this can lead to swelling, redness, instability, and eventually a collapse of the foot’s structure. Many patients notice that the foot becomes warm, swollen, and progressively deformed.
Surgery is focused on realigning and stabilizing the bones—often using plates, screws, or external frames—to create a more functional and supportive foot. While not every patient requires surgery, it can be an essential step in advanced cases to prevent further complications and significantly reduce the risk of amputation.
What Causes Charcot Neuroarthropathy?
Peripheral neuropathy—most commonly from diabetes, leading to loss of sensation in the feet. It can also be caused by conditions such as kidney disease or chronic alcohol use.
What Are the Symptoms of Charcot Neuroarthropathy?
Redness
in the foot or ankle
Swelling
that may appear suddenly and worsen with activity
Warmth
in the affected foot, which may feel significantly warmer than the other
How Do We Treat Charcot Neuroarthropathy
- Osteotomies—cutting and realigning bones to restore a more natural foot shape and correct deformities.
- Joint fusions (arthrodesis)—stabilizing and permanently fusing joints that are unstable or have collapsed.
- Internal fixation—using screws, plates, or rods to hold bones in the corrected position as they heal.
- External fixation (frames)—an option when internal hardware is not safe or appropriate due to infection or poor bone quality.
- Soft-tissue reconstruction—lengthening or releasing tight tendons (such as the Achilles tendon) to improve foot position and overall function.
When Is Surgery a Viable Option to Consider?
Severe foot deformity
that cannot be managed with bracing or custom footwear
Recurrent ulcers or wounds
caused by pressure from an abnormal foot shape
High risk of amputation
when surgical correction is needed to prevent further deterioration
Surgery Results and Goals
Stabilize the foot and ankle to allow safe weight-bearing
Realign bones and joints to prevent or treat ulcers caused by abnormal pressure points
Our ultimate goal is to preserve a functional limb and prevent—or delay—the need for amputation
Recovery and Results
Detailed Typical Post-Op Course for Major Charcot Reconstruction
Weeks 1-2
- Non-weight-bearing
- Immobilization in a splint, cast, or external fixator to protect the surgical site during early bone healing
- Skin checks and suture/staple removal typically within 7-10 days
Weeks 3-8
- Non-weight-bearing
- Periodic skin checks and serial radiographs of the foot and ankle to monitor healing progress and confirm successful fusions
Weeks 9-12
- Transition to weight-bearing only once approved by the surgeon -often in a CAM boot or custom brace
- Physical therapy to restore mobility, strength, and balance after immobilization
3-6 Months Post-Op
- Use of a custom orthopedic brace or Charcot Restraint Orthotic Walker (CROW) boot for long-term support and protection
Lifelong foot protection and monitoring to prevent recurrence, ulcers, or new Charcot events
Results
A stable, plantigrade foot
that can bear weight safely
Improved foot alignment
allowing effective use of custom footwear or braces
