Charcot Neuro-Osteoarthropathy in Diabetes: Implications for Diabetic Foot Ulcers, Amputations, and Survival

Charcot neuro-osteoarthropathy (CN) is a severe and often underrecognized complication of diabetes mellitus, primarily affecting individuals with diabetic neuropathy. Its clinical course is marked by progressive joint destruction and foot deformities. This review aims to summarize current evidence regarding the role of CN in the development and recurrence of diabetic foot ulcers (DFUs), the risk of amputation, and long-term survival outcomes, as well as to highlight key mechanisms contributing to these complications. Individuals with CN exhibit a significantly higher risk of DFUs, particularly in the midfoot region, due to structural deformities and increased plantar pressure. The risk of amputation is markedly elevated in individuals with CN, especially when DFUs are present. Mortality rates in CN are substantial, with five-year survival comparable to or worse than several malignancies. The development of foot ulcers and amputations in CN results from a complex interaction of neuropathy, structural deformity and chronic inflammation. Therefore, CN is a high-risk condition associated with serious foot complications and elevated mortality. Early recognition, multidisciplinary management, and further research into its independent prognostic impact are essential to improve long-term outcomes.