[Diabetic neuropathic osteoarthropathy (Charcot foot)]

Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot's foot) is a dramatic complication of diabetic polyneuropathy. The diabetic foot is the most neglected long-term sequela of diabetes mellitus, and this is especially true for DNOAP. The increasing number of diabetics presenting in the foot ambulance with DNOAP demonstrates this general lack of knowledge and indicates that this complication is more frequent than hitherto assumed. In view of this dilemma, the pathogenesis, diagnosis and therapy of DNOAP are reviewed. Special emphasis is given to the differentiation between the neuropathic and neuroischemic foot as well as between acute DNOAP and bacterial infection. Therapy of DNOAP is predominantly conservative. The indication for surgery should be restricted to serious deformities of the foot, instability of joints, imminent skin perforation caused by fracture-induced dislocation of bones, and recurrent ulcers caused by prominent bones. Surgery comprises ulcer excision, ablation of bony prominences, as well as orthopedic surgery for the reconstruction of the foot skeleton.