Ankle Charcot neuroarthropathy

Case contributed by Samir Benoudina
Diagnosis almost certain


Long standing diabetes. Presented for a gross ankle deformity.

Patient Data

Age: 50 years
Gender: Male

Resorption of the talar dome, loose bodies, and osteophytes around the ankle joint. There is also osteopenia and subluxation of the ankle joint, with widening of the tibiotalar joint space. In addition, dissociation of the distal tibiofibular joint and moderate periarticular edema. The above association of radiographic findings is characteristic of neuropathic osteoarthropathy.

Case Discussion

Charcot neuropathic joint (commonly referred to as Charcot’s joint) is a chronic, debilitating, limb-threatening condition affecting the musculoskeletal system, leading to progressive destruction of weight-bearing joints. Radiologically, Charcot joint is of two types: atrophic and hypertrophic (as in this case). Atrophic Charcot joint is characterized by bone resorption and osteolysis, usually localized to the forefoot. Hypertrophic Charcot joint is characterized by the “6 D’s” of hypertrophy: distended joints, density increases, debris production, dislocation, disorganization, and destruction. It usually occurs at the midfoot, rearfoot, or ankle joint.

The most frequently involved joints are the metatarsophalangeal joints, tarso-metatarsal, and tarsal joints, accounting for almost 65% of the cases. The ankle is involved in less than 10% of the cases.

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