The diabetic foot, neuropathy, ulcers and Charcot — the modern multidisciplinary pathway.

It is an umbrella term for the foot complications of diabetes — neuropathy (nerve damage), vasculopathy (poor circulation), immunopathy (impaired healing and infection defence), ulceration and Charcot arthropathy. These conditions interact and threaten the limb when they combine.

The International Working Group on the Diabetic Foot classifies people into risk categories 0–3 based on neuropathy, peripheral arterial disease, foot deformity and ulcer history. The category determines how often you are screened and what footwear or referral you need.

Charcot arthropathy destroys the bones and joints of the foot silently, because neuropathy masks the pain. Early it looks like cellulitis — warm, red and swollen without an ulcer. Rapid offloading and MDT referral prevent the classic collapsed rocker-bottom deformity that leads to ulceration and amputation.

A total contact cast is a well-moulded, non-removable below-knee cast that redistributes pressure across the whole foot and lower leg. It removes the option to weight-bear normally on the ulcer, which is why it heals neuropathic plantar ulcers faster than removable boots.

Intravenous antibiotics are indicated for limb-threatening infection — deep abscess, spreading cellulitis, osteomyelitis with systemic features, or diabetic foot sepsis. This is a hospital admission with surgical source control alongside antibiotics, not a course of oral tablets at home.

A specialist diabetic foot service brings together diabetes physicians, vascular and orthopaedic surgeons, podiatrists, tissue viability nurses, orthotists and microbiologists in one clinic. Compared with fragmented care, MDT services consistently reduce major amputation rates and improve ulcer healing.