Charcot foot marks a patient in trouble, not just a foot in trouble

Design

regional registry-based cohort study using linked routine healthcare data, 2015-2024, with time-to-event and multivariable regression

Population

140 adults with diabetes and a first recorded Charcot neuro-osteoarthropathy diagnosis, from 127,513 adults with diabetes; mean age 59, 67% men

Primary outcome

emergency hospitalisation, lower-extremity amputation, all-cause mortality and amputation-free survival

Effect

87.9% admitted, 31.4% amputated, 37.9% died over median 4.6 years; 5-year survival 67%, amputation-free survival 44%; high foot-risk status sHR 8.52 (2.05-35.45) for amputation

Charcot neuro-osteoarthropathy is usually framed as an orthopaedic and offloading problem. This registry cohort linked routine health data across NHS Greater Glasgow and Clyde from 2015 to 2024, identifying 140 adults with a first recorded diagnosis out of 127,513 with diabetes — and followed what happened to them.

Over a median 4.6 years, 87.9% had an emergency admission, 31.4% had a lower-extremity amputation and 37.9% died. Five-year survival was 67% and five-year amputation-free survival 44%, with a median of 4.04 years. Chronic kidney disease stages 4 and 5 was associated with worse outcomes across the board. High or active foot-risk status was independently associated with amputation (subdistribution hazard ratio 8.52, 95% CI 2.05-35.45) and shorter amputation-free survival (HR 2.09, 1.15-3.80); older age with higher mortality (HR 3.04, 1.50-6.16).

A 140-patient regional cohort in one Scottish health board cannot be generalised in its exact numbers, and the wide intervals show it. The direction is unambiguous enough to change how the diagnosis is treated administratively: a new Charcot diagnosis should trigger the same intensity of systemic review as a new myocardial infarction — renal function, cardiovascular risk, glycaemia, and a named multidisciplinary follow-up — rather than a cast and a review in six weeks.

• Treat a new Charcot diagnosis as a marker of systemic vulnerability, not an isolated foot problem
• Check renal function at diagnosis: advanced CKD tracked with worse outcomes across every endpoint
• Book structured multidisciplinary follow-up rather than open-access review
• Review cardiovascular risk management at the same appointment as the offloading plan
• In India, where podiatry access is scarce, secure the follow-up pathway before the patient leaves the clinic

The statistics, in plain English

With 140 patients the proportions are reasonably stable but the regression estimates are not: a subdistribution hazard ratio of 8.52 with an interval from 2.05 to 35.45 tells you the direction and almost nothing about the size. Amputation-free survival combines amputation and death into one endpoint, so the 44% at five years reflects both. A registry identifies people with a recorded diagnosis, and Charcot is under-recognised, so the 140 found among 127,513 with diabetes are likely the more severe or better-investigated cases.

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