Aim: Charcot foot is a rare but devastating complication of diabetes, leading to uncontrolled inflammation and high risk of osteolysis in its acute phase. Preserved local perfusion is a hypothesized prerequisite for the detrimental inflammatory response. We sought support for this hypothesis by studying the prevalence of previous lower limb revascularisation (LLR), as a marker of peripheral macroangiopathy, in patients with diabetes and Charcot foot.
Methods: Patients with diabetes and incident acute Charcot foot, but without a history of diabetic foot ulcers (DFU) (Charcot group, N=50) were retrospectively identified in a database used for quality of care monitoring in 36 Belgian specialized diabetic foot clinics in the period 2005-2011.  Patients without Charcot foot, but who had diabetic foot ulcers (DFU), served as controls (DFU group, N=3,147). Prevalence of previous LLR was compared between both groups using logistic regression.
Results: The Charcot group was significantly younger than the DFU group (59.1 vs. 69.1 years, P<0.001). Age-adjusted prevalence of previous LLR was significantly lower in the Charcot group than in the DFU group (3.5 vs. 29.8%, P<0.05), while the age-adjusted prevalence of coronary artery disease and stroke did not significantly differ (41.7 vs. 38.3%, P>0.05).
Conclusions: Charcot foot in diabetes only seems to occur in patients without a history of LLR. Despite the limitation of the cross-sectional nature of this study, our findings support the hypothesis that among patients with diabetes, Charcot foot occurs preferentially when lower limb perfusion is preserved.
 Doggen K, Diabetes Metab Res Rev. 2014;30(5):435-43.