Presentation
Chronic diabetes with a plantar surface ulcer. Request to exclude septic arthritis and osteomyelitis.
Patient Data
Features consistent with a typical Charcot foot in a known diabetic patient.
The presence of demonstrates this:
sclerosis (density change)
osseous fragmentation and destruction of the tarsal bones (destruction)
intraarticular loose bodies (debris)
soft tissue swelling and joint effusion (distention)
disorganisation of the midfoot
tarsometatarsal joint malalignment (dislocation)
There is mural vascular calcification.
There is a chronic plantar surface ulcer.
There is no plain film evidence of gas gangrene, septic arthritis or osteomyelitis.
There is degenerative plantar calcaneal spurring and Achilles insertional enthesopathy.
Case Discussion
The 6 Ds are well demonstrated in this diabetic patient to confirm a neuropathic or Charcot foot.
Osteomyelitis and septic arthritis cannot be definitively excluded here and hence an MRI was suggested.
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