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Charcot Foot with PAD — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesCharcot Foot with PADRACP Adult Medicine

A 62-year-old woman with longstanding type 2 diabetes develops a painless swollen right foot. X-ray shows neuropathic joint changes in the midfoot. She has absent pedal pulses on the right. Her ankle-brachial index is 0.45. What additional management is critical?

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Correct answer: A — Vascular surgery referral for peripheral arterial disease assessment

While Charcot neuroarthropathy requires offloading and total contact casting, the absent pedal pulses and ABI of 0.45 indicate significant peripheral arterial disease. Concurrent PAD in a diabetic patient with a neuropathic foot dramatically increases the risk of non-healing wounds, ulceration, and amputation. Urgent vascular surgery referral for assessment (CT angiography, consideration of revascularisation) is essential. The PAD must be addressed alongside the Charcot management.

Reference: eTG – 2025 – Cardiovascular; IWGDF – 2023 – PAD in Diabetic Foot Guidelines