Charcot arthropathy and necrotising cellulitis

Case contributed by Dr Craig Hacking


Foot pain and difficulty walking.

Patient Data

Age: 60 - 65 years
Gender: Male

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 midfoot 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.


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 arthropathy.

Case Discussion

The classic features of a Charcot joint, several of which are seen here, are (see mnemonic):

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

Case information

rID: 35802
Case created: 24th Apr 2015
Last edited: 13th Aug 2017
Inclusion in quiz mode: Included

Updating… Please wait.

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.