Why is it common for there to be a delay between onset of signs and diagnosis of Charcot foot?
The initial signs of Charcot foot are non-specific and are more typically seen in other more common conditions such as infections and rheumatologic conditions. Many patients do not have pain or have pain from neuropathy that was preexisting. Physicians who are not specialists in orthopaedic foot and ankle problems may see a Charcot foot very few times in an entire career, less frequently than other conditions such as septic arthritis, gout, rheumatoid arthritis and other inflammatory arthropathies.
Does a delay between onset of signs and diagnosis worsen the prognosis?
Not necessarily. Some cases of Charcot arthropathy become unstable in the very early stages and have destabilized before the patient sees the doctor. Other cases may destabilize even if the foot and ankle are optimally protected early in the course of the problem. Early protection may help decrease risk of further instability in some patients, but instability might occur despite early protection. The massive bony fragmentation may cause instability very differently than a fracture resulting from trauma in a non-neuropathic patient.