Charcot foot: most patients are admitted, a third lose a limb and over a third die within five years

Design

Regional registry-based retrospective cohort, 2015–2024

Population

140 adults with diabetes and a first recorded Charcot neuro-osteoarthropathy diagnosis (from 127,513 with diabetes), Glasgow

Primary outcome

Emergency hospitalisation, lower-limb amputation, death and amputation-free survival

Effect

Over median 4.6 years: 87.9% emergency admission, 31.4% amputation, 37.9% died; 5-year amputation-free survival 44%

A registry cohort from NHS Greater Glasgow and Clyde linked routine data on 127,513 adults with diabetes and found 140 with a first recorded Charcot neuro-osteoarthropathy (CNO) diagnosis between 2015 and 2024. Mean age was 59 and two-thirds were men.

Over a median 4.6 years, 88% had at least one emergency admission, 31% had a minor or major lower-limb amputation and 38% died. Estimated 5-year survival was 67% and 5-year amputation-free survival 44%. Events clustered early after diagnosis. Stage 4–5 chronic kidney disease was associated with worse outcomes across the board; a high or active foot-risk status was associated with a much higher amputation risk; older age with higher mortality.

The cohort is small and from one region, and the associations are adjusted but observational. Even so, the absolute numbers are stark enough to change how the diagnosis is handled: CNO is not only an orthopaedic problem of the midfoot, it marks a patient with advanced neuropathy, often advanced kidney disease and a high short-term risk of dying.

In practice that means treating a new CNO diagnosis as a trigger for a full cardiovascular and renal review, not only offloading, and making sure the patient is under a multidisciplinary foot service from the first visit.

• Treat a new Charcot diagnosis as a high-risk marker: review cardiovascular risk, renal function and medicines at the same visit.
• Refer to a multidisciplinary foot team straight away; complications cluster in the first year.
• Check eGFR — stage 4–5 CKD was associated with worse amputation and survival outcomes.
• Record foot-risk status at every review; high or active risk was linked to about an eightfold higher amputation hazard.
• Suspect Charcot in any warm, swollen, neuropathic foot, even without pain, and offload until it is excluded.

Why it matters

It reframes Charcot foot from a local joint problem into a marker of systemic vulnerability, with one in three patients dead within five years.

Don't overread it

With 140 patients from one Scottish region, the risk-factor estimates are imprecise and associational.

The statistics, in plain English

A subdistribution hazard ratio of 8.52 for amputation sounds huge, but its 95% confidence interval runs from 2.05 to 35.45 — the direction is clear, the size is not. The survival percentages are the more reliable take-away: roughly one in three patients died and fewer than half were alive without an amputation at five years.

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