Charcot reconstruction: the collapsed, deformed midfoot or hindfoot is realigned through osteotomies, bone excision, and fusion using large screws, beams, or circular frames. The goal is a plantigrade (flat) foot that fits in a shoe without pressure points. Ulcer debridement: infected or non-healing tissue is excised, bone may be resected if osteomyelitis is present, and the wound is managed with negative pressure therapy or local flaps. Tendon lengthening (particularly Achilles) may be performed to reduce forefoot pressure. The operation varies from 30 minutes (debridement) to four hours (Charcot reconstruction).
Surgery is considered for Charcot deformity that cannot be braced and causes recurrent ulceration, osteomyelitis not responding to antibiotics, chronic non-healing ulcers with correctable underlying deformity, and acute diabetic foot infections requiring urgent debridement.
Total contact casting for acute Charcot, custom orthotics and bracing, offloading footwear, wound care, antibiotics for infection, and vascular assessment and revascularisation for ischaemia.
Vascular assessment (ABPI, duplex ultrasound, or angiography) — adequate blood supply is essential for healing. Blood sugar optimisation. Infection control. Multidisciplinary diabetic foot team involvement. Nutritional assessment.
Creation of a plantigrade, shoeable foot that can be protected with appropriate footwear and orthotics. Resolution of chronic ulceration by removing the underlying pressure point. Eradication of bone infection.
Wound healing problemsCommon
The most significant concern. Diabetic patients have impaired wound healing.
Prolonged non-weight-bearingExpected
Six to twelve weeks or longer for Charcot reconstruction.
RecurrenceCommon
Ulcers may recur if footwear and offloading are not maintained.
Prolonged antibioticsExpected
For osteomyelitis.
Non-unionCommon
Very high risk in Charcot bone. May need revision.
AmputationUncommon
If healing fails or infection spreads. Minor (toe/ray) or major (below/above knee).
Charcot recurrenceUncommon
The Charcot process may continue or recur at adjacent joints.
Hardware failureCommon
Screws and plates may fail in soft Charcot bone.
Deep infectionUncommon
Particularly with internal fixation in compromised tissue.
Contralateral foot problemsCommon
The other foot is at equal risk.
General or spinal anaesthesia. Regional ankle block for post-operative pain (neuropathic patients may have reduced pain). Careful positioning — insensate feet are vulnerable to pressure injury.
Non-weight-bearing for six to twelve weeks (Charcot reconstruction). Total contact cast or boot. Gradual transition to weight-bearing in a custom orthotic and diabetic footwear. Lifelong specialist footwear, orthotics, and foot surveillance. Regular podiatry. The contralateral foot must also be monitored.
Frequent wound reviews. Regular X-rays. Lifelong diabetic foot surveillance. Multidisciplinary foot team reviews.
What is Charcot foot?
Charcot neuroarthropathy is a destructive condition where the bones and joints of the foot collapse and fragment due to loss of protective sensation (neuropathy). The foot becomes deformed, creating pressure points that ulcerate. It is most common in diabetic patients with peripheral neuropathy.
Can amputation be avoided?
With prompt, expert management, most diabetic foot complications can be managed without major amputation. The key is early recognition, multidisciplinary care, vascular assessment, infection control, and appropriate offloading.