Jeffcoate, WJ, F Game, and PR Cavanagh. :The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. .Lancet 366::2058. ,2005. .
Boyce, BF and L Xing. :Functions of RANKL/RANK/OPG in bone modeling and remodeling. .Arch Biochem Biophys 473::139. ,2008. .
Uccioli, L, A Sinistro, C Almerighi, et al. :Proinflammatory modulation of the surface and cytokine phenotype of monocytes in patients with acute Charcot foot. .Diabetes Care 33::350. ,2010. .
Mabilleau, G, NL Petrova, ME Edmonds, et al. :Increased osteoclastic activity in acute Charcot’s osteoarthropathy: the role of receptor activator of nuclear factor-kappaB ligand. .Diabetologia 51::1035. ,2008. .
Stevens, MJ, ME Edmonds, AV Foster, et al. :Selective neuropathy and preserved vascular responses in the diabetic Charcot foot. .Diabetologia 35::148. ,1992. .
Young, MJ, A Marshall, JE Adams, et al. :Osteopenia, neurological dysfunction, and the development of Charcot neuroarthropathy. .Diabetes Care 18::34. ,1995. .
Veves, A, CM Akbari, J Primavera, et al. :Endothelial dysfunction and the expression of endothelial nitric oxide synthetase in diabetic neuropathy, vascular disease, and foot ulceration. .Diabetes 47::457. ,1998. .
Shapiro, SA, KB Stansberry, MA Hill, et al. :Normal blood flow response and vasomotion in the diabetic Charcot foot. .J Diabetes Complications 12::147. ,1998. .
Baker, N, A Green, S Krishnan, et al. :Microvascular and C-fiber function in diabetic Charcot neuroarthropathy and diabetic peripheral neuropathy. .Diabetes Care 30::3077. ,2007. .
Jeffcoate, WJ and FL Game. :“New Theories on the Causes of the Charcot Foot in Diabetes,”. inThe Diabetic Charcot Foot: Principles and Management. ed byFrykberg, RG. , p29. ,Data Trace Publishing Company. ,Brooklandville, MD. ,2010. .
Herbst, SA, KB Jones, and CL Saltzman. :Pattern of diabetic neuropathic arthropathy associated with the peripheral bone mineral density. .J Bone Joint Surg Br 86::378. ,2004. .
Hofbauer, LC, CC Brueck, SK Singh, et al. :Osteoporosis in patients with diabetes mellitus. .J Bone Miner Res 22::1317. ,2007. .
Matricali, GA, B Bammens, D Kuypers, et al. :High rate of Charcot foot attacks early after simultaneous pancreas-kidney transplantation. .Transplantation 83::245. ,2007. .
Pitocco, D, G Zelano, G Gioffrè, et al. :Association between osteoprotegerin G1181C and T245G polymorphisms and diabetic Charcot neuroarthropathy: a case-control study. .Diabetes Care 32::1694. ,2009. .
Foltz, KD, LM Fallat, and S Schwartz. :Usefulness of a brief assessment battery for early detection of Charcot foot deformity in patients with diabetes. .J Foot Ankle Surg 43::87. ,2004. .
Eichenholtz, SN . :Charcot Joints. ,Charles C. Thomas. ,Springfield, IL. ,1966. .
Charcot, J-M and C Fere. :Affections osseuses et articulaires du pied chez les tabétiques (Pied tabétique) [in French]. .Archives de Neurologie 6::305. ,1883. .
Cofield, RH, MJ Morrison, JW Beabout, et al. :Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change. .Foot Ankle 4::15. ,1983. .
Johnson, JT . :Neuropathic fractures and joint injuries. Pathogenesis and rationale of prevention and treatment. .J Bone Joint Surg Am 49::1. ,1967. .
Armstrong, DG, WF Todd, LA Lavery, et al. :The natural history of acute Charcot’s arthropathy in a diabetic foot specialty clinic. .Diabet Med 14::357. ,1997. .
Henderson, VE . :Joint affections in tabes dorsalis. .J Pathol 10::211. ,1905. .
Caputo, GM, J Ulbrecht, PR Cavanagh, et al. :The Charcot foot in diabetes: six key points. .Am Fam Physician 57::2705. ,1998. .
Jeffcoate, W . :The causes of the Charcot syndrome. .Clin Podiatr Med Surg 25::29. ,2008. .
McGill, M, L Molyneaux, T Bolton, et al. :Response of Charcot’s arthropathy to contact casting: assessment by quantitative techniques. .Diabetologia 43::481. ,2000. .
Sinha, S, CS Munichoodappa, and GP Kozak. :Neuro-arthropathy (Charcot joints) in diabetes mellitus (clinical study of 101 cases). .Medicine (Baltimore) 51::191. ,1972. .
Sanders, LJ and RG Frykberg. :“The Charcot Foot (Pied de Charcot),”. inLevin and O’Neal’s The Diabetic Foot, ,7th Ed. , ed byBowker, JH and MA Pfeifer. , p257. ,Mosby Elsevier. ,Philadelphia. ,2007. .
Morrison, WB, CP Shortt, and AYI Ting. :“Imaging of the Charcot foot,”. inThe Diabetic Charcot Foot: Principles and Management. ed byFrykberg, RG. , p65. ,Data Trace Publishing Company. ,Brooklandville, MD. ,2010. .
Morrison, WB and HP Ledermann. :Work-up of the diabetic foot. .Radiol Clin North Am 40::1171. ,2002. .
Morrison, WB, HP Ledermann, and ME Schweitzer. :MR imaging of the diabetic foot. .Magn Reson Imaging Clin N Am 9::603. ,2001.
Larcos, G, ML Brown, and RT Sutton. :Diagnosis of osteomyelitis of the foot in diabetic patients: value of 111In-leukocyte scintigraphy. .AJR Am J Roentgenol 157::527. ,1991. .
Palestro, CJ, HH Mehta, M Patel, et al. :Marrow versus infection in the Charcot joint: indium-111 leukocyte and technetium-99m sulfur colloid scintigraphy. .J Nucl Med 39::346. ,1998. .
Keidar, Z, D Militianu, E Melamed, et al. :The diabetic foot: initial experience with 18F-FDG PET/CT. .J Nucl Med 46::444. ,2005. .
Hopfner, S, C Krolak, S Kessler, et al. :Preoperative imaging of Charcot neuroarthropathy. Does the additional application of 18F-FDG-PET make sense? Nuklearmedizin 45::15. ,2005. .
Frykberg, RG and M Eneroth. :“Principles of conservative management,”. inThe Diabetic Charcot Foot: Principles and Management. ed byFrykberg, RG. , p93. ,Data Trace Publishing Company. ,Brooklandville, MD. ,2010. .
Armstrong, DG and LA Lavery. :Monitoring healing of acute Charcot’s arthropathy with infrared dermal thermometry. .J Rehabil Res Dev 34::317. ,1997. .
Armstrong, DG, LA Lavery, S Wu, et al. :Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. .Diabetes Care 28::551. ,2005. .
Armstrong, DG, B Short, EH Espensen, et al. :Technique for fabrication of an “instant total-contact cast” for treatment of neuropathic diabetic foot ulcers. .J Am Podiatr Med Assoc 92::405. ,2002. .
Selby, PL, MJ Young, and AJ Boulton. :Bisphosphonates: a new treatment for diabetic Charcot neuroarthropathy. ?Diabet Med 11::28. ,1994. .
Jude, EB, PL Selby, J Burgess, et al. :Bisphosphonates in the treatment of Charcot neuroarthropathy: a double-blind randomised controlled trial. .Diabetologia 44::2032. ,2001. .
Pitocco, D, V Ruotolo, S Caputo, et al. :Six-month treatment with alendronate in acute Charcot neuroarthropathy: a randomized controlled trial. .Diabetes Care 28::1214. ,2005. .
Anderson, JJ, KE Woelffer, JJ Holtzman, et al. :Bisphosphonates for the treatment of Charcot neuroarthropathy. .J Foot Ankle Surg 43::285. ,2004. .
Hofbauer, LC, C Hamann, and PR Ebeling. :Approach to the patient with secondary osteoporosis. .Eur J Endocrinol 162::1009. ,2010. .
Bem, R, A Jirkovská, V Fejfarová, et al. :Intranasal calcitonin in the treatment of acute Charcot neuroosteoarthropathy: a randomized controlled trial. .Diabetes Care 29::1392. ,2006. .
Molines, L, P Darmon, and D Raccah. :Charcot’s foot: newest findings on its pathophysiology, diagnosis and treatment. .Diabetes Metab 36::251. ,2010. .
Ulbrecht, JS and DK Wukich. :The Charcot foot: medical and surgical therapy. .Curr Diab Rep 8::444. ,2008. .
Wukich, DK and W Sung. :Charcot arthropathy of the foot and ankle: modern concepts and management review. .J Diabetes Complications 23::409. ,2009. .
Strauss, E and G Gonya. :Adjunct low intensity ultrasound in Charcot neuroarthropathy. .Clin Orthop Relat Res 349::132. ,1998. .
Hockenbury, RT, M Gruttadauria, and I McKinney. :Use of implantable bone growth stimulation in Charcot ankle arthrodesis. .Foot Ankle Int 28::971. ,2007. .
Petrisor, B and JT Lau. :Electrical bone stimulation: an overview and its use in high risk and Charcot foot and ankle reconstructions. .Foot Ankle Clin 10::609. ,2005. .
Pinzur, MS . :“Surgical Management: History and General Principles,”. inThe Diabetic Charcot Foot: Principles and Management. , ed byFrykberg, RG. , p165. ,Data Trace Publishing Company. ,Brooklandville, MD. ,2010. .
Dhawan, V, KF Spratt, MS Pinzur, et al. :Reliability of AOFAS diabetic foot questionnaire in Charcot arthropathy: stability, internal consistency, and measurable difference. .Foot Ankle Int 26::717. ,2005. .
Lavery, LA, DG Armstrong, AJ Boulton, et al. :Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. .JAPMA 92::479. ,2002. .
Armstrong, DG and LA Lavery. :Elevated peak plantar pressures in patients who have Charcot arthropathy. .J Bone Joint Surg Am 80::365. ,1998. .
Hastings, MK, MJ Mueller, DR Sinacore, et al. :Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus. .J Orthop Sports Phys Ther 30::85. ,2000. .
Maluf, KS, MJ Mueller, MJ Strube, et al. :Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait. .J Biomech 37::897. ,2004. .
Holstein, P, M Lohmann, M Bitsch, et al. :Achilles tendon lengthening, the panacea for plantar forefoot ulceration? Diabetes Metab Res Rev 20 ( Suppl 1:):S37. ,2004. .
Mueller, MJ, DR Sinacore, MK Hastings, et al. :Impact of Achilles tendon lengthening on functional limitations and perceived disability in people with a neuropathic plantar ulcer. .Diabetes Care 27::1559. ,2004. .
Catanzariti, AR, R Mendicino, and B Haverstock. :Ostectomy for diabetic neuroarthropathy involving the midfoot. .J Foot Ankle Surg 39::291. ,2000. .
Rosenblum, BI, JM Giurini, LB Miller, et al. :Neuropathic ulcerations plantar to the lateral column in patients with Charcot foot deformity: a flexible approach to limb salvage. .J Foot Ankle Surg 36::360. ,1997. .
Laurinaviciene, R, K Kirketerp-Moeller, and PE Holstein. :Exostectomy for chronic midfoot plantar ulcer in Charcot deformity. .J Wound Care 17::53. ,2008. .
Mittlmeier, T, K Klaue, P Haar, et al. :Should one consider primary surgical reconstruction in Charcot arthropathy of the feet. ?Clin Orthop Relat Res 468::1002. ,2010. .
Simon, SR, SG Tejwani, DL Wilson, et al. :Arthrodesis as an early alternative to nonoperative management of Charcot arthropathy of the diabetic foot. .J Bone Joint Surg Am 82-A::939. ,2000. .
Papa, J, M Myerson, and P Girard. :Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle. .J Bone Joint Surg Am 75::1056. ,1993. .
Pakarinen, TK, HJ Laine, SE Honkonen, et al. :Charcot arthropathy of the diabetic foot. Current concepts and review of 36 cases. .Scand J Surg 91::195. ,2002. .
Stone, NC and TR Daniels. :Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy. .Can J Surg 43::449. ,2000. .
Pinzur, M . :Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. .Foot Ankle Int 25::545. ,2004. .
Garapati, R and SB Weinfeld. :Complex reconstruction of the diabetic foot and ankle. .Am J Surg 187( 5A:):81S. ,2004. .
Assal, M and R Stern. :Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. .J Bone Joint Surg Am 91::812. ,2009. .
Pinzur, MS . :Neutral ring fixation for high-risk non-plantigrade Charcot midfoot deformity. .Foot Ankle Int 28::961. .2007. .
Farber, DC, PJ Juliano, PR Cavanagh, et al. :Single stage correction with external fixation of the ulcerated foot in individuals with Charcot neuroarthropathy. .Foot Ankle Int 23::130. ,2002. .
Fabrin, J, K Larsen, and PE Holstein. :Arthrodesis with external fixation in the unstable or misaligned Charcot ankle in patients with diabetes mellitus. .Int J Low Extrem Wounds 6::102. ,2007. .
Wukich, DK, RJ Belczyk, and PR Burns. :Complications encountered with circular ring fixation in persons with diabetes mellitus. .Foot Ankle Int 29::994. ,2008. .
Bevilacqua, NJ and LC Rogers. :Surgical management of Charcot midfoot deformities. .Clin Podiatr Med Surg 25::81. ,2008. .
Rogers, LC, NJ Bevilacqua, RG Frykberg, et al. :Predictors of postoperative complications of Ilizarov external ring fixators in the foot and ankle. .J Foot Ankle Surg 46::372. ,2007. .
Connolly, JF and TA Csencsitz. :Limb threatening neuropathic complications from ankle fractures in patients with diabetes. .Clin Orthop Relat Res 348::212. ,1998. .
Jani, MM, WM Ricci, J Borrelli Jr, et al. :A protocol for treatment of unstable ankle fractures using transarticular fixation in patients with diabetes mellitus and loss of protective sensibility. .Foot Ankle Int 24::838. ,2003. .
Perry, MD, WS Taranow, A Manoli 2nd, et al. :Salvage of failed neuropathic ankle fractures: use of large-fragment fibular plating and multiple syndesmotic screws. .J Surg Orthop Adv 14::85. ,2005. .
Wukich, DK, A Joseph, M Ryan, et al. :Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. .Foot Ankle Int 32::120. ,2011. .
Ayoub, MA . :Ankle fractures in diabetic neuropathic arthropathy: can tibiotalar arthrodesis salvage the limb. ?J Bone Joint Surg Br 90::906. ,2008. .
Dalla Paola, L, A Volpe, D Varotto, et al. :Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure. .Foot Ankle Int 28::967. ,2007. .
Caravaggi, C, M Cimmino, S Caruso, et al. :Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot. .J Foot Ankle Surg 45::20. ,2006. .
Pinzur, MS and T Noonan. :Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. .Foot Ankle Int 26::545. ,2005. .
The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity. (J Am Podiatr Med Assoc 101(5): 437–446, 2011)