Neuropathic joint disease (Charcot arthropathy)
The hot, swollen, painless or mildly painful foot in someone with neuropathy. Which neuropathies hit which joints, the 2 °C temperature rule, X-ray then MRI, telling Charcot from cellulitis and osteomyelitis, and immediate offloading in a non-removable knee-high cast until remission (IWGDF 2023).
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Charcot neuro-osteoarthropathy is progressive bone and joint destruction in a limb with loss of protective sensation. Unfelt trauma and autonomic neuropathy (increased blood flow, osteoclast activation through RANKL) drive fractures, dislocation and collapse.
- In Australia the cause is almost always diabetes, with the midfoot (tarsometatarsal and naviculocuneiform joints) affected most.
- The active foot is red, hot and swollen with intact skin and less pain than expected. Missed, it collapses into a rocker-bottom foot that ulcerates, gets infected and leads to amputation.
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Sources
- Wukich DK, Schaper NC, Gooday C et al. Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023). Diabetes Metab Res Rev 2024;40:e3646International Working Group on the Diabetic Foot, 2023 (current until the 2027 IWGDF update)
- 2021 Australian evidence-based guidelines for diabetes-related foot diseaseAU/NZDiabetes Feet Australia (Australian Diabetes Society), 2021 (no separate Charcot chapter; Charcot care follows IWGDF)
- Therapeutic Guidelines: Diabetes (diabetes-related foot disease)AU/NZTherapeutic Guidelines Limited (eTG complete), current online version, accessed November 2026
- Rogers LC, Frykberg RG, Armstrong DG et al. The Charcot foot in diabetes. Diabetes Care 2011;34:2123-9American Diabetes Association and American Podiatric Medical Association, 2011
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy