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We propose that a fundamental change in the approach and assumptions regarding the historical treatment of active CNO should be considered. Although the true incidence and prevalence of CNO in the US population with diabetes are not known, we estimated the incidence to be 27,602 per year and the prevalence to be 208,880 persons. In persons with diabetes, the incidence of CNO is higher than that of prostate, lung, kidney, and thyroid cancer, and in the entire US population, the incidence of CNO is higher than that of multiple myeloma, soft tissue sarcoma, and primary bone sarcoma. In persons with diabetes, the incidence of CNO is higher than fractures of the femoral shaft, distal femur, tibia, talus, calcaneus and Lisfranc ligament injuries. Surgical techniques have evolved over the past half century, and surgery is the standard for treating displaced fractures and intra\u2010articular injuries. Since CNO is a fracture, dislocation, or fracture dislocation in patients with neuropathy, why do we treat CNO differently? Elsewhere in the skeleton displaced osseous and ligament injuries are treated surgically. Based on the information presented in this manuscript, we suggest that it is time for a paradigm shift in the treatment of persons with CNO. While uncommon, CNO in persons with diabetes is not rare. Given the advances in surgical techniques, surgical intervention should be considered earlier in persons with CNO who are at risk for developing deformity related foot ulceration.<\/jats:p>","DOI":"10.1002\/dmrr.3754","type":"journal-article","created":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T01:04:32Z","timestamp":1702083872000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Charcot neuroarthropathy in persons with diabetes: It's time for a paradigm shift in our thinking"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3637-6208","authenticated-orcid":false,"given":"Dane K.","family":"Wukich","sequence":"first","affiliation":[{"name":"University of Texas Southwestern Orthopaedic Surgery  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-303X","authenticated-orcid":false,"given":"Robert G.","family":"Frykberg","sequence":"additional","affiliation":[{"name":"Podiatric Medicine Midwestern University Glendale  Glendale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venu","family":"Kavarthapu","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgeon \u2013 King's College Hospital  London UK"},{"name":"Orthopaedic Lead King's Diabetic Foot Unit  London UK"},{"name":"University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620x.48b1.4"},{"key":"e_1_2_10_3_1","first-page":"7","volume-title":"Evolution of Charcot Joints: Stage of Development, Stage of Coalescence, Stage of Reconstruction. 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