Charcot's foot.

Charcot's foot used to be considered an unusual complication of diabetic peripheral neuropathy. With the current appreciation that approximately 25% of adult diabetics have an appreciable peripheral neuropathy, it is understandable that Charcot's neuro-osteoarthropathy has become recognized as a major problem for clinicians caring for diabetics. Differentiation from acute diabetic foot infection is the first challenge. Once Charcot's foot is identified, treatment generally involves immobilization during the acute inflammatory stage. When deformity develops, the orthopedic foot and ankle surgeon must decide whether accommodative care with a combination of inlay depth shoes, accommodative foot orthoses, and ankle-foot orthoses is adequate. If a plantigrade weight-bearing surface cannot be achieved, surgical stabilization or reconstruction requires rigid stabilization in a poor biomechanical environment using tools that are not designed for structures as small as the foot. The controversies presented to clinicians charged with care of this difficult patient population are as follows: 1. When to allow weight bearing in the acute phase of the disease process. 2. Whether prefabricated devices are as successful as the total contact cast in the acute phase. 3. Early surgical stabilization versus accommodation when deformity first develops. 4. Late reconstruction versus accommodation or amputation in the deformed late stages.