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Mortality in patients with diabetic neuropathic osteoarthropathy (Charcot foot)
A Gazis1, N Pound, R Macfarlane
1Foot Ulcer Trials Unit, Department of Diabetes and Endocrinology, City Hospital, Nottingham NG5 1PB, UK.
Insights
Patients with Charcot foot experienced higher mortality than expected, though amputation rates were similar to those with uncomplicated diabetic neuropathy. Neuropathy itself may be linked to increased mortality in diabetes.
Area of Science:
- Diabetology
- Orthopedics
- Vascular Surgery
Background:
- Charcot neuropathic osteoarthropathy (Charcot foot) is a serious complication of diabetes.
- Understanding the long-term outcomes, including mortality and amputation rates, is crucial for patient management.
Purpose of the Study:
- To determine the mortality rate in patients with Charcot foot managed at a specialist unit.
- To compare mortality and amputation incidence with a matched control group of patients with uncomplicated neuropathic ulceration.
Main Methods:
- Retrospective analysis of a database of Charcot foot cases from a specialist diabetic foot clinic.
- Individual matching of control patients for age, gender, diabetes type and duration, and referral year.
- Comparison of survival and amputation rates between Charcot foot patients and controls.
Main Results:
- Forty-seven Charcot foot cases were identified, with 38.3% having Type 1 diabetes.
- Mortality was 44.7% in the Charcot group versus 34.0% in the control group over a mean follow-up of 3.7 and 3.1 years, respectively.
- Major amputation rates were 23.4% for Charcot patients and 10.6% for controls, with no statistically significant difference.
Conclusions:
- Charcot foot patients exhibited higher mortality than anticipated.
- No significant difference in mortality or amputation was found between Charcot foot and uncomplicated neuropathic ulceration.
- Neuropathy, rather than Charcot osteoarthropathy, may be independently associated with increased mortality in diabetes, warranting further investigation.
Objective:
To determine the mortality of a population of patients diagnosed with Charcot neuropathic osteoarthropathy managed by a single specialist unit and to compare the results with a control population.
Methods:
We have undertaken a retrospective analysis of all cases of Charcot foot on the comprehensive database which has been maintained at the specialist diabetic foot clinic at the City Hospital, Nottingham since 1982. Survival and the incidence of amputation (major and minor) was compared with a control population referred with uncomplicated neuropathic ulceration. Controls were individually matched for gender, age (+/-2 years), disease type, disease duration (+/-2 years) and year of referral (+/-3 years).
Results:
Forty-seven cases (21 female, 26 male) of Charcot foot were identified, of whom 18 (38.3%) had Type 1 diabetes. Mean age and disease duration at presentation were 59.2 +/- 13.4 (sd) and 16.2 +/- 11.2 years, compared with 59.7 +/- 12.6 and 16.3 +/- 11.2 years, respectively, in the controls. Twenty-one (44.7%) of those with Charcot had died, after a mean interval of 3.7 +/- 2.8 years. This compared with 16 (34.0%) after a mean 3.1 +/- 2.7 years in the control group. Mean duration of follow-up in the survivors was 4.7 +/- 4.9 years (Charcot) and 5.3 +/- 3.9 years (controls). A total of 11 (23.4%) Charcot patients had had a major amputation on the side of the index lesion, compared with five (10.6%) controls. There was no difference between the two groups (P > 0.05, Chi-square).
Conclusions:
The mortality in this group of patients with Charcot foot was higher than expected. Nevertheless, there was no difference between those with Charcot and those with uncomplicated neuropathic ulceration. It is possible that it is neuropathy, rather than Charcot osteoarthropathy, which is independently associated with increased mortality in diabetes. The mechanism underlying any such association is not known. There is a need for a formal, prospective, multicentre study to investigate the life expectancy and cardiovascular risk of those with Charcot osteoarthropathy.
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