Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Charcot neuroarthropathy (Charcot foot) — progressive bone and joint destruction from neuropathic fracture-dislocation in the setting of peripheral neuropathy — is one of the most limb-threatening complications of diabetes. The acute Charcot foot is frequently misdiagnosed as cellulitis or deep vein thrombosis because swelling, erythema, and warmth are prominent and X-rays may appear normal in the earliest stage. Delayed diagnosis allows continued weight-bearing that drives progressive bone destruction and deformity, leading to a rocker-bottom foot deformity that dramatically increases ulceration risk and ultimately amputation risk.
Eichenholtz Staging
Eichenholtz Stage 0 (prodromal): clinical findings (unilateral warmth, swelling, erythema) without radiographic evidence of bony injury — the most commonly missed stage. Skin temperature differential >2°C between feet using an infrared thermometer is a key diagnostic sign. Stage I (development/fragmentation): acute fractures, fragmentation, and joint subluxation visible on X-ray — continued weight-bearing drives progressive destruction. Stage II (coalescence): bone resorption slows, early callus formation, skin temperature begins to normalize — transition from acute to subacute. Stage III (consolidation): bony consolidation with sclerosis, stable deformity, skin temperature normalized — the chronic phase.
Treatment by Stage
Stage 0–II: immediate total contact casting with strict non-weight-bearing — the most critical intervention to halt bone destruction. The diagnostic criteria: unilateral warmth and swelling in a diabetic patient with peripheral neuropathy should be treated as acute Charcot foot until proven otherwise — early total contact casting is far less harmful than delayed treatment. Duration of casting: until skin temperature differential <2°C (typically 3–6 months), followed by Charcot restraint orthotic walker (CROW) for 1–2 years. Stage III with stable deformity: custom Charcot restraint orthotic walker or custom accommodative footwear; surgery (osteotomy or arthrodesis) is indicated for deformity producing recurrent ulceration that cannot be managed with footwear. Dr. Biernacki at Balance Foot & Ankle maintains a high index of suspicion for acute Charcot in diabetic patients presenting with unilateral foot swelling and warmth. Call (810) 206-1402 for urgent diabetic foot evaluation at our Bloomfield Hills or Howell office.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
Frequently Asked Questions
How often should diabetics have their feet checked by a podiatrist?
People with diabetes should have a comprehensive foot examination by a podiatrist at least once per year, and more frequently (every 1–3 months) if they have neuropathy, poor circulation, history of foot ulcers, or active foot problems.
What is the biggest foot danger for diabetics?
Loss of protective sensation (neuropathy) combined with poor circulation creates a dangerous combination — minor injuries can go unnoticed and become infected. Foot ulcers affect 15–25% of diabetics over their lifetime and are the leading cause of non-traumatic amputations.
Does Medicare cover diabetic foot care?
Yes. Medicare covers annual diabetic foot exams for patients with peripheral neuropathy, as well as therapeutic shoes and inserts under the Diabetic Shoe Bill. Balance Foot & Ankle accepts Medicare.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.