Charcot Neuroarthropathy Is Associated With Higher Rates of Phantom Limb After Lower Extremity Amputation

Q: What was the study’s main purpose regarding phantom limb pain?

To determine whether patients with Charcot neuroarthropathy and diabetes have increased phantom limb pain rates after BKA or AKA compared with patients with diabetes alone.

Q: How were the comparison groups defined in the study?

Group A included patients with both diabetes and Charcot neuroarthropathy undergoing BKA or AKA, while Group B included patients with diabetes without Charcot neuroarthropathy undergoing BKA or AKA.

Sep 29, 2026

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Incidence of phantom limb pain in hospitalized patients with Charcot neuroarthropathy undergoing major lower-extremity amputation is poorly characterized. This study assessed whether patients with Charcot neuroarthropathy and diabetes receiving either below-knee amputation (BKA) or above-knee amputation (AKA) show higher phantom limb pain rates than patients with diabetes alone. Using TriNetX ICD and CPT codes (2012–2022), diabetic cohorts were compared for demographics and relative risk after BKA or AKA.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Phantom limb pain and proposed mechanisms

Materials and Methods

Data source and cohort definitions

Variables and statistical approach

Foot&Ankle Specialist February 2026 〈 Clinical Research 〉 Charcot Neuroarthropathy Is Associated With Higher Rates of Phantom Limb After Lower Extremity Amputation Hannah H. Nam, BA , Brandon J. Martinazzi, MD , F. Jeffrey Lorenz, MD, Gregory J. Kirchner, MD, MPH, Vincenzo Bonaddio, MD, Adeshina Adeyemo, MD , Kempland C. Walley, MD , and Michael C. Aynardi, MD Abstract: Background. The incidence of phantom limb pain inpatients with Charcot neuroarthropathy who undergo major amputation is not well described. The purpose of this study was to determine whether patients with Charcot neuroarthropathy and diabetes who underwent either a below-knee amputation (BKA) or above-knee amputation (AKA) had an increased rate of phantom limb pain compared with those with a diagnosis of diabetes alone. Methods. Using international classification of disease (ICD) and common procedural terminology (CPT) codes, the TriNetX research database identified 10 239 patients who underwent BKA and 6122 who underwent AKA between 2012 and 2022. Diabetic patients with and without Charcot neuroarthropathy were compared in terms of demographics and relative risk of developing phantom limb pain after AKA or BKA. Results. Age, sex, ethnicity, and race did not significantly differ between groups. Charcot neuroarthropathy was associated with significantly increased risk of phantom limb pain following both BKA (risk ratio [RR]: 1.2, 95% confidence interval [CI]: 1.1-1.3, P < . 01) and AKA (RR: 1. 6, 95% CI: 1.2-2.3, P < . 0068) . Conclusion. Our results indicate that patients with a coexisting diagnosis of Charcot consequence of long-standing peripheral neuropathy and repetitive microtrauma.1 First described as a sequela of late-stage syphilis, Charcot neuroarthropathy is now the most prevalent among patients with uncontrolled diabetes.2 Given the neuroarthropathy who require BKA or AKA may have an increased risk of developing phantom limb pain. Levels of Evidence: Level III Keywords: diabetes; amputation and limb salvage; Charcot’s disease; “The increased risk of developing phantom limb pain in Charcot patients suggests that prophylactic interventions for reducing phantom limb pain may be important to consider in this patient population.” complex foot and ankle conditions; peripheral neuropathy Introduction Charcot neuroarthropathy is a devastating condition that arises as a continued rise in patients diagnosed with diabetes, it is likely that the number of patients who develop Charcot will continue to increase.2,3 Charcot neuroarthropathy is also associated with high rates of morbidity and mortality.4 Sohn et al. reported a 23% vol. 19 / no. 1 Foot&Ankle Specialist lower risk of mortality in patients with diabetes alone compared with those with Charcot neuroarthropathy. This study also showed that 34% of patients with Charcot neuroarthropathy developed foot ulcers, which significantly increases the risk of amputation. The risk of amputation was 12 times higher in patients with both Charcot neuroarthropathy and foot ulcers but only 7 times higher in patients with ulceration in the absence of Charcot neuroarthropathy.5 Phantom limb pain is a phenomenon in which patients experience painful shooting, burning, or cramping sensations in a part of their body that has been amputated.6 The etiology of phantom limb pain is unknown, but the proposed mechanism is thought to involve reorganization and structural changes to both the peripheral and central nervous systems.7 Possible treatments for phantom limb pain include pharmacological approaches, such as pre-emptive analgesia and anesthesia before amputation, acetaminophen and nonsteroidal anti-inflammatories, opioids, and antidepressants, as well as nonpharmacological treatments, such as transcutaneous electrical nerve stimulation (TENS), mirror therapy, spinal cord stimulation, peripheral nerve stimulation, transcranial magnetic stimulation, and regenerative peripheral nerve

FAQs

What was the study’s main purpose regarding phantom limb pain?

To determine whether patients with Charcot neuroarthropathy and diabetes have increased phantom limb pain rates after BKA or AKA compared with patients with diabetes alone.

How were the comparison groups defined in the study?

Group A included patients with both diabetes and Charcot neuroarthropathy undergoing BKA or AKA, while Group B included patients with diabetes without Charcot neuroarthropathy undergoing BKA or AKA.

What did the results show about phantom limb pain risk?

Charcot neuroarthropathy was associated with significantly increased risk of phantom limb pain after both BKA and AKA.

Sep 29, 2026

Upload by Alexandar