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Extensive bone remodeling/fragmentation involving the midfoot in this patient with a poorly controlled diabetes, compatible with Charcot's joint (neuropathic arthropathy).
This location is highly suggestive of a diabetic etiology; other location are characteristic :
- wrist : diabetes, syringomyelia
- hip : alcohol, tabes dorsalis
- knee : tabes dorsalis, congenital insensitivity to pain
- ankle & foot : diabetes
- spine : spinal cord injury, diabetes, tabes dorsalis
- dense bones (subchondral sclerosis)
- destruction of articular cartilage
- deformity (pencil-point deformity of metatarsal heads)
- debris (loose bodies)
The main differential diagnosis is osteomyelitis and, in some cases, it can evolve as fast.