Charcot's Arthropathy - Management Management of acute Charcot's arthropathy Prevention of further destruction and deformity of the foot at the acute phase is the primary goal of treatment. It is therefore essential to prevent the patient walking on the fragile bones until they have a chance to heal. The mainstay of current treatment is placing the foot in a well moulded contact cast to relieve pressure and to preserve foot shape. Patients remain in the contact cast until there is no major difference in the temperature and swelling between the affected and unaffected feet. This usually takes between 6-9 months. Application of a contact cast       If treated early, the foot is not grossly deformed. Patients can avoid the need for specialist footwear and have a good chance of avoiding ulceration. If not treated early, the foot affected by Charcot's arthropathy becomes very deformed and ulcer prone. Treatment at this stage is palliative and relies on special foot wear, regular podiatry treatment and limitation of activities. Amputation is sometimes required because of intractable ulceration. Therefore diagnosing Charcot's arthropathy at the acute stage of a "swollen foot" is essential and limb saving.   A grossly deformed Charcot's joint with neuropathic ulcer.           Specific treatment There is no proven specific pharmacological treatment for Charcot's arthropathy. There has been a report that a group of drugs known as the biphosphonates may be useful. These are currently undergoing clinical trials.