Charcot Neuro-Osteoarthropathy (CNO) is a debilitating complication predominantly affecting individuals with diabetes and peripheral neuropathy. Radiological assessment plays a central role in the diagnosis, staging, and management of CNO. While
plain radiographs remain the cornerstone of initial imaging, advanced modalities such as
Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) have significantly
enhanced diagnostic accuracy. Nuclear imaging, including bone scintigraphy, radiolabeled
leukocyte scans, and FDG-PET/CT, offers additional diagnostic precision in complex cases,
especially when differentiating CNO from infections or evaluating patients with metal implants. This review underscores the importance of a multimodal imaging approach suited
to the clinical stage and specific diagnostic challenges of CNO. It highlights the critical need
for standardized imaging protocols and integrated diagnostic algorithms that combine
radiological, clinical, and laboratory findings. Advances in imaging biomarkers and novel
techniques such as diffusion-weighted MRI hold promise for improving early detection
and monitoring treatment efficacy. In conclusion, the effective management of CNO in
diabetic foot patients requires a multidisciplinary approach that integrates advanced imaging technologies with clinical expertise. Timely and accurate diagnosis not only prevents
debilitating complications but also facilitates the development of personalized therapeutic
strategies, ultimately improving patient outcomes.