Long-term limb salvage and functional recovery in advanced Charcot neuroarthropathy complicated by a non-healing diabetic foot ulcer: a CARE-compliant case report

Background Advanced Charcot neuroarthropathy complicated by diabetic foot ulceration is a limb-threatening condition associated with progressive foot deformity, recurrent ulceration, infection, impaired wound healing, and a high risk of major amputation. Evidence describing long-term limb preservation following multimodal conservative management remains limited. Case presentation A 43-year-old man with poorly controlled type 2 diabetes mellitus and diabetic peripheral neuropathy presented with advanced Charcot neuroarthropathy of the left foot, complicated by a chronic, non-healing dorsal diabetic foot ulcer (3 × 4 cm; Wagner Grade 3; University of Texas Grade 3-D) and a lateral draining sinus. During the earlier course of the disease, magnetic resonance imaging demonstrated extensive Charcot-related bony destruction with findings suggestive of secondary osteomyelitis. The diagnosis was made by the treating podiatric surgeon based on clinical and imaging findings. Microbiological and histopathological confirmation was not available. Despite prior hospitalization, incision and drainage, and approximately 15 days of intravenous antibiotic therapy, satisfactory wound healing was not achieved. Intervention The patient underwent multimodal conservative management comprising continuation of conventional antidiabetic therapy, complete bed rest during the active wound-management period, structured local wound care using Aragvadhadi Kashayam, internal Ayurvedic medications (Pachanamritham Kashayam and Chandraprabha Vati), dietary regulation, and regular clinical follow-up. Custom-made protective footwear had previously been prescribed for the Charcot-related deformity and was used for approximately six months before discontinuation because of discomfort. Outcomes Progressive reduction in wound exudate and slough was followed by healthy granulation tissue formation, complete epithelialization of the dorsal ulcer, and healing of the lateral draining sinus. Limb preservation was achieved without major amputation over approximately four years of follow-up. The patient subsequently regained independent ambulation, resumed routine occupational and daily activities, and maintained functional mobility. The clinical course was documented through serial clinical photographs and follow-up assessments. Conclusion This case describes a favorable long-term outcome, including limb preservation and functional recovery, following multimodal conservative management in a patient with advanced Charcot neuroarthropathy complicated by chronic ulceration. Given the single-case design and the simultaneous use of multiple therapeutic interventions, the independent contribution of individual treatment components cannot be determined. Further prospective studies are warranted.