What investigations are recommended to confirm the diagnosis of Charcot foot in diabetic patients?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Recommended investigations to confirm the diagnosis of Charcot foot in diabetic patients include:

  • Arrange a weight-bearing X-ray of the affected foot and ankle to identify characteristic changes associated with acute Charcot arthropathy.
  • If the X-ray is normal but clinical suspicion remains high, consider an MRI to detect early bone and soft tissue changes not visible on X-ray.
  • Refer the patient urgently (within 1 working day) to a multidisciplinary foot care service for further assessment and management.
  • Use clinical assessment including monitoring foot-skin temperature differences and serial X-rays to support diagnosis and monitor progression.

These steps help differentiate Charcot arthropathy from other causes of foot redness, swelling, and deformity in diabetic patients, especially in the presence of peripheral neuropathy or renal failure.

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