Understanding Charcot and Diabetic Bone Disease.

Charcot neuroarthropathy and diabetic bone disease share a unifying pathophysiology characterized by inflammatory osteolysis, vascular rarefaction, neurotrophic failure, and progenitor exhaustion. Once viewed as a localized mechanical process in an insensate foot, Charcot is now understood as a systemic marrow niche collapse driven by chronic inflammation and metabolic stress. This article outlines the molecular, cellular, and structural mechanisms underlying this process and explores emerging diagnostic and therapeutic approaches designed to restore osteoimmunologic balance and bone integrity in the diabetic host.