Treatment

• the affected joints cannot recover. However they may be stabilized by an external splintage.
  
• the underlying condition e.g. diabetes, syphilis, syringomyelia, is treated as appropriate.

Note;

To confirm the diagnosis of acute diabetic Charcot arthropathy of the ankle or foot, refer the patient within one working day to your local multidisciplinary foot care service for triage within one further working day. Offer non-weight-bearing treatment until definitive treatment can be started by the multidisciplinary foot care service (1)

Bisphosphonates may help the acute phase of Charcot as they inhibit osteoclastic reabsorption. Calcitonin also serves as an antiresorptive agent. Alternative agents include pamidronate or zoledronic acid which act on new hydroxyapatite crystal by blocking osteoclast precursors in the newly formed bone matrix. (2)

Surgery is indicated for patients with severe or unstable deformities that, if untreated, will result in major amputations (3)

Reference

1. NICE. Diabetic foot problems: prevention and management. NICE guideline NG19. Published August 2015, last updated October 2019
2. Durgia H, Sahoo J, Kamalanathan S, et al; Role of bisphosphonates in the management of acute Charcot foot. World J Diabetes. 2018 Jul 15;9(7):115-126
3. Varma AK; Charcot neuroarthropathy of the foot and ankle: a review. J Foot Ankle Surg. 2013 Nov-Dec;52(6):740-9.