Condition · Foot and ankle
Diabetic foot and Charcot neuroarthropathy
Neuropathy can reduce protective pain, allowing a wound, fracture or Charcot neuroarthropathy to progress before the patient recognises its severity. A newly warm, red and swollen foot on one side requires prompt assessment.
Clinical context
What you should know
The diabetic foot encompasses different problems: neuropathy, ischaemia, ulceration, infection and deformity. Charcot is an active neuro-osteoarthropathy and should not automatically be confused with infection, although the two can coexist.
The absence of pain does not mean the absence of risk. Blood supply, wound depth and infection affect healing and sometimes require a multidisciplinary team.
First step
Consultation and assessment
Assessment includes a complete skin examination, sensation, pulses, comparison of foot temperature, stability and radiographs. Blood tests, MRI, microbiology samples or vascular assessment are selected according to suspected infection and lesion depth.
When active Charcot is suspected, offloading should not be delayed until every investigation is complete. Ulceration or infection may require input from diabetes, infectious diseases, vascular surgery and wound-care teams.
Stepwise treatment
Options are chosen according to the diagnosis and treatment goal
Conservative treatment
- offloading and immobilisation in an appropriate device until Charcot activity resolves, with frequent monitoring
- a CROW orthosis or therapeutic footwear after stabilisation, tailored to the deformity and skin risk
- treatment of infection only after appropriate clinical and microbiological assessment; antibiotics do not treat an uninfected Charcot foot
- metabolic and vascular optimisation and management of plantar pressure within a multidisciplinary strategy
Medication, injections and devices each have their own indications and contraindications. They are not recommended automatically and do not replace a diagnosis or monitoring of the response.
When surgery is considered
Reconstruction is reserved for unstable deformity that cannot be accommodated in an orthosis, recurrent ulceration or threatened skin. Before surgery, infection, blood supply, metabolic control and the ability to comply with prolonged offloading must be assessed.
Do not delay
Signs that require prompt assessment
- a newly warm, red and swollen foot in a person with neuropathy or diabetes
- a wound with discharge or odour, blackened skin, fever or chills
- a cold, pale or blue toe or foot, or pain at rest
- feeling generally unwell, confusion or difficult-to-control blood glucose associated with a wound
In an emergency or if symptoms are severe, call 112 or go to the nearest emergency department.
Frequently asked questions
Concise answers, without blanket promises
Is Charcot treated with antibiotics?
Not when there is no infection. The mainstay of treatment in the active phase is offloading and immobilisation. Antibiotics are indicated only for a diagnosed infection.
Why is it urgent if it does not hurt?
Neuropathy reduces the warning signal. Continued loading can cause fractures, collapse and wounds, so unilateral warmth and swelling require prompt assessment.
Editorial responsibility
Medically reviewed content
Dr. Răzvan Anițaș
Consultant orthopaedic and trauma surgeon; PhD in medical sciences
Last editorial update: 22 August 2026
Medical reference sources
First step
Consultation, diagnosis and a clearly explained plan
This content is educational and does not replace medical assessment. Similar symptoms can have different causes and require different treatments.