Charcot Foot and Advanced Wound Care Management

Charcot neuroarthropathy—commonly referred to as Charcot foot—is a rare but serious and disabling condition that can cause widespread destruction of bones, joints, and soft tissue structures, ultimately leading to significant loss of function and potential amputation. ¹

Why Early Diagnosis Matters

In its early stages, Charcot foot is frequently overlooked—often due to a lack of familiarity among healthcare providers. Swelling, redness, and warmth in the foot may be mistaken for cellulitis, deep vein thrombosis, or osteomyelitis. As a result, many patients are not diagnosed until more advanced stages, when irreversible damage has already occurred—making treatment more complex and outcomes less favorable.

Charcot neuroarthropathy is driven by a complex pathophysiology involving unregulated osteoclast activity and progressive bony breakdown. ² The earlier it’s recognized, the greater the chance to preserve limb function and prevent complications.

Key Signs and Diagnostic Tools

Charcot neuroarthropathy is a multifactorial process characterized by unregulated osteoclast activity and progressive bony destruction. Classically, patients present with an edematous, erythematous foot that feels noticeably warmer than the opposite limb.

These non-specific signs are often mistaken for cellulitis, deep vein thrombosis, or osteomyelitis—making clinical suspicion especially important in patients with peripheral neuropathy. ³

Typical early symptoms include:

• Noticeable warmth in one foot compared to the other

• Redness and significant swelling without an open wound

• Intact skin despite deep structural changes

  
  

Prompt diagnosis relies on high clinical suspicion—especially in patients with neuropathy—and appropriate imaging. X-rays can reveal bone fragmentation or joint collapse, while MRI provides better soft tissue detail and can help rule out infection. ⁵

The Role of Wound Centers and Podiatric Collaboration

Once suspected, immediate immobilization using total contact casting or removable walkers is the foundation of early management. Delayed or inadequate offloading can dramatically worsen outcomes.

Wound care centers play a vital role in managing Charcot foot by bringing together multidisciplinary expertise. Among the most critical team members: podiatrists.

Podiatrists help:

• Confirm the diagnosis through clinical evaluation and imaging

• Implement immobilization and offloading protocols

• Determine when surgical intervention may be needed

• Monitor progression and prevent ulcer formation

  
  

Charcot foot cases demand sustained, coordinated care—often over several months. Early recognition and collaborative management between podiatrists, wound care clinicians, and orthopedic teams is essential to preventing deformity, ulceration, infection, and potential limb loss while preserving function and quality of life. ⁴

SHS Spotlight

With more than 25 years of experience in wound care and hyperbaric program development, Shared Health Services equips hospitals and healthcare providers with the resources, tools, and peer-to-peer expertise needed to build successful, sustainable HBOT programs. We work directly with center staff—serving as trusted liaisons—to provide clinical guidance, compliance support, and training aligned with the highest standards of care. From managing complex cases like Charcot neuroarthropathy to strengthening documentation workflows, our goal is to empower teams, elevate outcomes, and support local wound care efforts through proven strategies and hands-on collaboration.

References:

1. Marmolejo, V. S., Arnold, J. F., Ponticello, M., & Anderson, C. A. (2018). Charcot foot: clinical clues, diagnostic strategies, and treatment principles. American Family Physician, 97(9), 594–599.

2. Schmidt, B. M. (2020). Clinical insights into Charcot foot. Best Practice & Research Clinical Rheumatology, 101563.

3. Schmidt, B. M., & Holmes, C. M. (2019). Influence of patient setting and dedicated limb salvage efforts on outcomes in Charcot-related foot ulcer. The International Journal of Lower Extremity Wounds, 18(4), 362–366.

4. Trieb, K. (2016). The Charcot foot: pathophysiology, diagnosis, and classification. The Bone & Joint Journal, 98(9), 1155–1159.

5. Yousaf, S., Dawe, E. J., Saleh, A., Gill, I. R., & Wee, A. (2018). The acute Charcot foot in diabetics: diagnosis and management. EFORT Open Reviews, 3(10), 568–573.

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