Charcot Neuro-osteoarthropathy: Critical Concepts and Practical Management Pearls for Dermatologists

Charcot neuro-osteoarthropathy (CNO), formerly known as Charcot's arthropathy, is a progressive joint and bone disorder primarily affecting the bones of the feet. It usually occurs secondary to neuropathic damage from conditions like diabetes and leprosy. This chronic condition evolves through acute inflammatory and later chronic phases, characterized by joint destruction and instability. Pathophysiological mechanisms involve neurotraumatic and neurovascular theories, along with newer insights such as altered neuropeptide signaling, including calcitonin gene-related peptide, and dysregulation of the osteoprotegerin pathway, leading to increased osteoclastic activity and bone resorption. Clinical presentation ranges from acute inflammation marked by swelling, erythema, and warmth to chronic stages characterized by pain, joint deformities, and functional impairment. Diagnosis relies on clinical assessment, radiography, and magnetic resonance imaging for early detection and accurate staging. Management involves a multidisciplinary approach and includes conservative measures with total contact casting for offloading, and surgical options for severe deformities or recurrent ulcers. Early recognition and intervention are crucial to prevent progression and complications, emphasizing the role of dermatologists, especially leprologists, in timely diagnosis and management. In this review, we discuss the pathophysiology, clinical features, classification systems, investigations, and management of CNO.