The Charcot foot (neuro-osteoarthropathic arthropathy) is a severe, destructive complication of diabetic foot syndrome. The combination of neuropathy and unnoticed microtrauma leads to rapid destruction of bones, joints and soft tissues of the foot - often without the affected person feeling any pain.
Causes and pathophysiology
Charcot foot occurs almost exclusively in patients with advanced diabetic neuropathy. The loss of pain sensitivity means that even the smallest injuries or incorrect strain go unnoticed. The foot is subjected to further stress, causing inflammation, bone loss and severe deformities.
Symptoms and early signs
Acute Charcot foot is a medical emergency. Typical signs are:
- Sudden, one-sided swelling and redness of the foot
- Significant overheating when comparing sides
- Paradoxical lack of pain despite severe bone and joint damage
- Later: Deformities such as sinking of the arch of the foot (“rocking foot”) or prominent bones on the sole of the foot
Diagnostics
Diagnosis is primarily clinical and imaging:
- Clinical examination (temperature difference, swelling)
- X-ray, MRI or CT to show bone destruction
- Rule out infection or gout through laboratory values
Stage classification according to Eichenholtz
| stage | Description |
|---|---|
| Stage 0 | Initial stage – swelling and overheating, X-ray still unremarkable |
| Stage I | Active destruction – bone fragmentation and joint destruction |
| Stage II | Cohesion phase – resorption of bone fragments |
| Stage III | Consolidation – healing with permanent deformity |
Therapy and management
The primary goal is to maintain the shape of the foot and avoid ulcers:
- Immediate absolute relief (total contact cast or special orthosis for several months)
- After healing: lifelong care with custom-made orthopedic shoes
- For severe deformities: surgical correction
- Optimal blood sugar control
Further information:
→ Diabetes mellitus – knowledge and overview
→ Why hyporest
→ Diabetic foot syndrome
Sources
- German Diabetes Society (DDG). S3 guideline “Diabetic foot syndrome”. As of 2025. Available at: www.deutsche-diabetes-gesellschaft.de/leitlinien.
- American Diabetes Association. Standards of Medical Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1). Available at: diabetesjournals.org.
- Robert Koch Institute (RKI). Federal health reporting – diabetes mellitus in Germany. Berlin 2024.
- International Diabetes Federation (IDF). IDF Diabetes Atlas. 11th edition. Brussels 2025. Available at: diabetesatlas.org.
Important note:
The information in this encyclopedia article is intended solely for general and non-binding information. They do not replace medical advice, diagnosis or therapy. If you have any health questions or complaints, please always consult a doctor or qualified healthcare professional. The content was created with the greatest possible care, but errors cannot be completely ruled out.
Last updated: February 26, 2026
