Charcot arthropathy and necrotising cellulitis

Case contributed by Dr Craig Hacking

Presentation

Foot pain and difficulty walking

Patient Data

Age: 58
Gender: Male
Modality: X-ray

The second toe has been amputated at the level of the metatarsal head. There is extensive dorsal soft tissue swelling containing gas centred on the first metatarsophalangeal joint. Hallux valgus deformity is noted however there is relative sparing of the joint space. No erosions or periarticular osteopenia is demonstrated. No soft tissue calcification. There is joint destruction across the mid foot involving the tarsometatarsal joints suggestive of Charcot's arthropathy however there is no obvious Lisfranc joint disruption. Incidental spurs arise from the posterior and plantar aspects of the calcaneum and the anterior process of the talus. Mild vascular calcification noted.

Conclusion

Soft tissue infection of the dorsal forefoot over the first MTP joint with gas forming organism (necrotising cellulitis). There is however little evidence of septic arthritis or osteomyelitis. Midfoot changes in a diabetic highly suggestive of Charcot's arthropathy.

Case Discussion

The classic features are a Charcot joint are (see mnemonic):

  • dense bones (subchondral sclerosis)
  • degeneration 
  • destruction of articular cartilage
  • deformity (pencil-point deformity of metatarsal heads)
  • debris (loose bodies)
  • dislocation
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Case Information

rID: 35802
Case created: 24th Apr 2015
Last edited: 3rd Sep 2015
Inclusion in quiz mode: Included

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