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We describe an atypical presentation of an active Charcot foot in a woman with a long-standing type 1 diabetes who did not exhibit loss of protective sensation (sensate to a 10-gram monofilament) or loss of vibration sensation. These standard measures of large nerve fibre function ruled out \u201cclassical\u201d neuropathy. However, additional testing showed reduced sweat gland function most likely related to degeneration of c-fibres (small fibre neuropathy). This case raises the awareness that in addition to the \u201ctextbook\u201d description, in diabetes, Charcot foot can develop in individuals with \u201cminimal\u201d or \u201cno signs\u201d of clinical neuropathy. The onset of active Charcot foot should be suspected in every person with diabetes and history of trauma even when foot and ankle x-rays are normal. Offloading should be initiated until the diagnosis is proven otherwise.<\/jats:p>","DOI":"10.1177\/15347346231166550","type":"journal-article","created":{"date-parts":[[2023,3,31]],"date-time":"2023-03-31T01:37:36Z","timestamp":1680226656000},"page":"856-861","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Onset of an Active Charcot Foot in a Person with Longstanding Type 1 Diabetes and Normal Vibration Perception Threshold\u2014A Case Report"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6937-6565","authenticated-orcid":false,"given":"Nina L.","family":"Petrova","sequence":"first","affiliation":[{"name":"King's College Hospital NHS Foundation Trust"},{"name":"School of Cardiovascular and Metabolic Medicine &amp; Sciences, Faculty of Life Sciences &amp; Medicine, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rumaisa","family":"Banatwalla","sequence":"additional","affiliation":[{"name":"King's College Hospital NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharine F.","family":"Hunt","sequence":"additional","affiliation":[{"name":"King's College Hospital NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2765-7649","authenticated-orcid":false,"given":"Raju","family":"Ahluwalia","sequence":"additional","affiliation":[{"name":"King's College Hospital NHS Foundation Trust"},{"name":"King's College Hospital NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Elias","sequence":"additional","affiliation":[{"name":"King's College Hospital NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen","family":"Bates","sequence":"additional","affiliation":[{"name":"King's College Hospital NHS Foundation Trust"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7448-2995","authenticated-orcid":false,"given":"Prashanth R. 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