Foot and ankle
Charcot foot reconstruction
This procedure is reserved for deformity that cannot be safely accommodated with conservative measures and threatens weight-bearing or the skin.
General guidance
When it may be considered
- instability and collapse
- bony prominences and recurrent ulceration
- deformity that cannot be adequately offloaded with an orthosis
Individual decision
How suitability is determined
Infection control, blood supply, diabetes, neuropathy and the ability to comply with offloading are decisive factors.
An abnormal scan alone is not an indication for surgery. The symptoms, clinical examination, progression and the patient's goals must be considered together.
Surgical plan
Decisions that tailor the procedure
- ruling out or controlling infection and assessing the blood supply
- the stage of Charcot activity and whether reconstruction can be performed safely
- achieving a stable, plantigrade foot that can be protected
- the ability to comply with prolonged offloading and multidisciplinary follow-up
Alternatives
What is discussed before surgery
The mainstay of treatment is offloading and immobilisation until the active phase has resolved, followed by a CROW orthosis or therapeutic footwear. Ulceration, infection, ischaemia and metabolic control are managed separately; injections have no role in stabilising a Charcot foot.
Before the procedure
Preparation and safety
- any ulceration, infection or ischaemia must be assessed and treated before elective reconstruction;
- work with the medical team to optimise diabetes control and nutrition, and stop smoking;
- prepare for several months of strict offloading, assistive devices and help at home;
- bring details of previous wounds, microbiology results, antibiotic treatment and imaging.
After the procedure
Rehabilitation
Protection and offloading may continue for months, with frequent reviews, bracing and a gradual return to weight-bearing.
The exact protocol, permitted weight-bearing and follow-up schedule depend on the procedure performed and individual progress.
Informed consent
Risks and limitations
Risks include infection, non-union, recurrence, soft-tissue defects and loss of a plantigrade, weight-bearing foot.
No procedure can guarantee complete pain relief or a return to a particular level of activity.
After surgery
Signs that require prompt medical assessment
- fever, chills, discharge, an unusual odour or an enlarging wound;
- painful pressure, skin damage or moisture beneath the cast or orthosis;
- cold, pale or blue toes, or a sudden change in sensation;
- increasing warmth, redness or deformity of the foot during the protected period.
For severe symptoms or an emergency, call 112. The instructions given to you at discharge take priority over the general information on this page.
Editorial responsibility
Medically reviewed content
Dr. Răzvan Anițaș
Consultant orthopaedic and trauma surgeon; PhD in medical sciences
Last editorial update: 22 August 2026
Medical sources used for patient information
First step
Consultation, diagnosis and an individual treatment recommendation
This information does not replace a consultation. Surgery is recommended only after the individual benefits, alternatives and risks have been assessed.