What is it?
Without normal sensation, small fractures and joint injuries go unnoticed and continue to be walked on. An inflammatory process weakens the bones further, and the arch can collapse into a 'rocker-bottom' shape that creates pressure ulcers.
What causes it?
- Peripheral neuropathy from diabetes or other causes
- Minor trauma, sometimes unnoticed
- Recent foot surgery or infection in a neuropathic foot
What does it feel like?
- A warm, red, swollen foot — often with little or no pain
- A change in foot shape
- A foot noticeably warmer than the other
How is it diagnosed?
Temperature comparison between feet, X-rays, and often MRI. Charcot is frequently mistaken for infection, cellulitis, or a sprain.
When should you see a podiatrist?
- Right away — a warm, swollen foot in someone with neuropathy should be evaluated promptly
Nonsurgical treatment
- Immobilization
- A total contact cast or specialized boot until the active phase settles.
- Custom footwear and bracing
- Protect the foot long-term once stable.
- Close monitoring
- Serial X-rays and temperature checks.
When is surgery considered?
Reconstruction is considered for unstable deformity, deformity causing recurrent ulcers, or deformity that cannot be braced.
Charcot reconstruction realigns and fuses the collapsed joints with internal fixation, and sometimes external fixation, to create a stable, shoeable foot.
Related procedures
What is recovery like?
The active phase often takes several months of immobilization. Reconstruction requires an extended period of non-weight-bearing and a long-term plan for protective footwear.
Frequently asked questions
Is Charcot foot painful?
Often not very, because of neuropathy — which is why swelling and warmth, rather than pain, are the key warning signs.