Year: 2026 | Month: June | Volume: 13 | Issue: 6 | Pages: 524-533
DOI: https://doi.org/10.52403/ijrr.20260650
Charcot Neuropathic Osteoarthropathy: An Updated Literature Review on Pathophysiology, Diagnosis, and Management
I Made Ngurah Angga Prabawa1, I Gede Eka Wiratnaya2
1Resident of Orthoapedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
2Consultant of Orthopaedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Corresponding Author: I Made Ngurah Angga Prabawa
ABSTRACT
Charcot Neuropathic Osteoarthropathy (CNO) is a progressive complication of peripheral neuropathy, most commonly associated with diabetes mellitus, and is characterized by inflammation, bone and joint fragmentation, and deformity of the foot and ankle. This literature review summarizes current knowledge regarding the anatomy relevant to CNO, its multifactorial pathophysiology, diagnostic approach, classification systems, management strategies, and prognosis. Evidence indicates that CNO arises from an interaction of neurotraumatic and neurotrophic mechanisms, inflammatory cytokine imbalance, osteoclast overactivity, microvascular alterations, metabolic disturbances in chronic hyperglycemia, and genetic susceptibility within the OPG-RANK-RANKL pathway. Clinically, CNO presents with a warm, swollen, erythematous neuropathic foot and progresses through well defined stages described by the Eichenholtz system, while additional anatomical classifications by Trepman, Sanders Frykberg, and Brodsky, together with MRI based schemes, assist in staging and treatment planning. Diagnosis relies primarily on clinical suspicion supported by radiography and advanced imaging to document structural damage and to distinguish CNO from osteomyelitis and other inflammatory conditions. First line treatment is early immobilization and offloading using total contact casting or equivalent devices, with subsequent reconstructive procedures, such as osteotomy, arthrodesis, beaming constructs, and hybrid or external fixation, reserved for patients with fixed deformity, instability, or recurrent ulceration. Multidisciplinary care that optimizes glycemic control, vascular status, bone health, and infection management is essential. Infection and peripheral arterial disease substantially worsen outcomes and increase the risk of major amputation. Overall, timely recognition, accurate staging, and stage directed conservative and surgical interventions are crucial to preserving a plantigrade, shoeable, and infection free foot and to improving long term limb salvage and quality of life in patients with CNO.
Keywords: Charcot neuropathic osteoarthropathy, diabetic neuropathy, and total contact casting.
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