What are the recommended treatment options for Charcot foot in diabetic patients?

Treatment options for Charcot foot in diabetic patients include:

• Immediate non-weight-bearing treatment until definitive management can be started by a multidisciplinary foot care service.
• Use of a non-removable offloading device is recommended as the primary treatment for acute Charcot arthropathy.
• If a non-removable device is not suitable due to clinical or patient circumstances, a removable offloading device may be considered.
• Bisphosphonates should not be offered for treating acute Charcot arthropathy outside of clinical trials.
• Ongoing monitoring of treatment should be done through clinical assessment, including measuring foot-skin temperature differences and serial X-rays until resolution is confirmed.

People with foot deformities resulting from previous Charcot arthropathy are at high risk of ulceration and should be managed by a foot protection service.

Referral to a multidisciplinary foot care service should be prompt (within 1 working day for triage and further management) to confirm diagnosis and initiate treatment.

Imaging with weight-bearing X-rays is recommended to confirm diagnosis; MRI may be considered if X-rays are normal but suspicion remains.

These recommendations are based on the NICE guideline NG19: Diabetic foot problems: prevention and management ¹.