[Charcot foot. Current situation and outlook]

Neuro-osteoarthropathy is accompanied by the destruction of single or multiple joints involving little or no pain. Diabetic patients suffering from symmetric distal polyneuropathy are the main risk group. The main location is the foot (Charcot foot). Inadvertent or repetitive trauma appears to be the main trigger mechanism for Charcot foot. Undiagnosed and untreated fractures and dislocations, foot and ankle deformities and instabilities with consecutive ulcerations may be the consequence, which again may increase the risk for later extremity loss due to the need for amputation or at least functional deterioration. Early diagnosis in the acute phase is of the utmost importance for the patient's prognosis. The primary strategy consists of unloading and immobilizing the foot and the corresponding extremity followed by stage-related protected remobilization until definite healing occurs. Surgical intervention is a key-stone in the treatment of complications at any stage. Surgery is an essential part of treatment and should be integrated into the overall treatment plan. The main indications for orthopedic reconstruction are non-plantigrade foot and ankle deformities or instabilities with concomitant ulcers that cannot be adequately addressed by non-operative measures, mainly in the chronic stage of Charcot foot. As such, surgical reconstruction can contribute to the long-term preservation of the affected foot and help to maintain or improve the patient's mobility and quality of life.