Charcot neuroarthropathy of the foot: diagnosis, offloading and reconstruction

Charcot neuroarthropathy is a noninfective, progressive destruction of the bones and joints of a neuropathic foot that, when unrecognized, leads to deformity, ulceration, infection and amputation. This narrative review synthesizes the evidence published up to 2024 on the diagnosis, offloading and reconstruction of Charcot neuroarthropathy of the foot, organized by three thematic axes and their chronological trajectory. The synthesis indicates that diagnosis has shifted from radiographic staging toward earlier recognition with magnetic resonance imaging, although no single test reliably separates active Charcot from osteomyelitis. Offloading remains the cornerstone of management, with the total contact cast as reference standard, and earlier offloading in stage 0 shortens treatment and reduces recurrence. Reconstruction, reserved for deformity, instability and failed offloading, has evolved from exostectomy toward axial beaming and intramedullary nailing, but complication rates remain high. The evidence base is dominated by retrospective series and small trials, and comparative studies between techniques are scarce.