In patients with diabetic foot syndrome (DFS), anxiety disorder (ANX) and depression (DEP) reduce adherence to self-care and treatments, affect blood glucose control and lead to worse prognosis. Few studies explored the psycho-emotional implications of Charcot neuro-osteoarthropathy (Charcot). Our aim was to evaluate the relationship between the presence of Charcot and the risk of ANX or DEP. 47 diabetic patients were recruited from the AORN Cardarelli Diabetic Foot Care Center: 23 with diagnosis of Charcot (Charcot group, ChG) and 24 with DFS, without Charcot (DFG). Active foot ulcers, known cancer, serious illnesses, diagnosed psychiatric disorders or cognitive disabilities were exclusion criteria. The risk of ANX or DEP was evaluated with the Hospital ANX and DEP Scale (HADS) questionnaire and stratified accordingly: not at risk of ANX or DEP (score 0-7), borderline (8-10), or at high risk (score >10). The average score risk was also calculated. The groups did not differ for age, diabetes duration, HbA1c, education, complications or drug treatment. The risk of ANX score was 11.7±3.7 and 6.9±3.9 (M±SD) in ChG and DFG, respectively (p<0.001, Student’s t test). In the ChG, 61% were at high risk of ANX, 30% borderline, and 9% at no-risk. In contrast, in DFG only 37% were at high risk, 17% borderline, and 46% at no-risk (p<0.002 vs ChG, χ2). The risk of DEP score was 11.5±4.2 and 7.4±3.9 in ChG and DFG, respectively (p<0.002). In the ChG, 70% were at high risk of DEP, 17% borderline, and only 13% with no-risk. In contrast, in DFG only 34% were at high risk, 29% borderline, and 37% at no-risk (p<0.02 vs ChG). Using the HADS, subjects suffering from Charcot showed a significantly greater risk of ANX or DEP, compared to subjects with DF syndrome without Charcot, in absence of active foot ulcers. The dangerous relationship between ANX or DEP and Charcot may trigger a vicious circle potentially leading to a worse prognosis in patients with diabetes. Therefore, it could be very important to identify subjects at high risk of ANX or DEP with the purpose to provide an adequate treatment. On this regard, the use of the HADS questionnaire could represent an easy and valuable resource.