The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This is the first guideline on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes published by the IWGDF. We followed the GRADE Methodology to devise clinical questions in the PACO (Population, Assessment, Comparison, Outcome) and PICO (Population, Intervention, Comparison, Outcome) format, conducted a systematic review of the medical literature, and developed recommendations with the rationale. The recommendations are based on the evidence from our systematic review, expert opinion when evidence was not available, and also taking into account weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to an intervention. We here present the 2023 Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus and also suggest key future topics of research.

Department of Diabetes Diabetic Foot Clinic King's College Hospital NHS Foundation Trust London UK

Department of Orthopaedic Surgery University of Texas Southwestern Medical Center Dallas Texas USA

Department of Radiology UT Southwestern Medical Center Dallas Texas USA

Diabetes Centre Institute for Clinical and Experimental Medicine Prague Czechia

Division of Endocrinology MUMC CARIM and CAPHRI Institute Maastricht The Netherlands

Elsie Bertram Diabetes Centre Norfolk and Norwich University Hospitals NHS Foundation Trust Norfolk UK

Gustave Dron Hospital Univ Lille Lille France

Italian Hospital of Buenos Aires Buenos Aires Argentina

Program in Physical Therapy Washington University School of Medicine St Louis Missouri USA

Secretary International Association of Diabetic Foot Surgeons Mumbai India

The Division of Metabolism Endocrinology and Diabetes The University of Michigan Medical School Ann Arbor Michigan USA

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