Send to:

Choose Destination
See comment in PubMed Commons below
Diabet Foot Ankle. 2013 May 21;4. doi: 10.3402/dfa.v4i0.20981. Print 2013.

Pressure pain perception in the diabetic Charcot foot: facts and hypotheses.

Author information

  • 1Diabetic Foot Clinic, Department of Endocrinology and Diabetes, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.



Reduced traumatic and posttraumatic (nociceptive) pain is a key feature of diabetic neuropathy. Underlying condition is a gradual degeneration of endings of pain nerves (A-delta fibers and C-fibers), which operate as receivers of noxious stimuli (nociceptors). Hence, the absence of A-delta fiber mediated sharp pain ("first" pain), and of C-fiber mediated dull pain ("second" pain). However, patients with diabetic neuropathy and acute Charcot foot often experience deep dull aching in the Charcot foot while walking on it.


To create a unifying hypothesis on the kind of pain in an acute Charcot foot.


Absence of punctuate (pinprick) pain perception at the sole of a Charcot foot, as was shown recently, likely corresponds to vanished intraepidermal A-delta fiber endings. C-fiber nociceptors are reduced, according to histopathology studies. Both types of fibers contribute to posttraumatic hyperalgesia at the skin level, as studies show. Their deficiencies likely impact on posttraumatic hyperalgesia at the skin level and, probably, also at the skeletal level.


It is hypothesised that deep dull aching in an acute diabetic Charcot foot may represent faulty posttraumatic hyperalgesia involving cutaneous and skeletal tissues.


Charcot neuroarthropathy; diabetic neuropathy; pain perception

Free PMC Article
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Datapage Icon for PubMed Central
    Loading ...
    Write to the Help Desk