Background: Charcot foot is a rare but a limb-threatening condition in long-standing diabetic neuropathy.  This condition poses many clinical challenges in its diagnosis and management that can lead to severe deformity, disability, and even amputation.  However, limited data are available in Asian patients.  The aim of this study is to describe clinical presentations and outcomes of Charcot foot patients in a multi-disciplinary foot care service. 
Method:  We present our experience of 40 cases of Charcot foot treated from 2000 to 2016 at Theptarin Hospital. Medical records were analyzed retrospectively for clinical characteristics and outcomes. 
Result: During the study period, 40 Charcot foot patients were identified (13 acute, 27 chronic; mean age 58.7±10.2 years; 60% females).  All patients except two had type 2 diabetes mellitus.  Duration of diabetes was 18.0±8.8 years. The average A1C at initial presentation was 9.2±1.9% and almost 30% of patients had very poor glycemic control (A1C >10%).  More than half of the patients developed chronic kidney disease and diabetic retinopathy. Superimposed ulceration and osteomyelitis at the presentation of Charcot foot were common, and occurred in 48% and 13% of the patients, respectively.  Interestingly, previous episodes of acute Charcot foot were reported to have occurred in 2 patients of chronic Charcot, and 5 patients had bilateral disease of chronic Charcot foot at the initial presentation.  Surgical interventions included 4 exostectomies, 1 external fixation, 1 internal fixations, 1 arthrodesis and 2 major amputation.  Ulcer-free rate at 6 and 12 months were 60% and 58% of patients, respectively.  Median follow-up period was 57.1 months and mortality rate was 13% during follow-up period. Only 61% of patients could walk normally while almost one fourth of patients were wheelchair-bound.  
Conclusion: Charcot foot in Thai patients mainly developed in long-standing type 2 diabetes with neuropathy, and often presents late and superimposed ulceration. It also reflected the occurrences of various late diabetes complications. This rare condition requires careful initial and long term follow up as almost 20% of cases could have bilateral involvement.  Increased awareness of Charcot foot is a key in improving the patient outcome.

Outcomes of Diabetic Charcot Foot: A 17-year experience from a multi-disciplinary foot care service in Thailand