Presentation
One year of foot swelling and deformity. Past medical history of type 2 diabetes.
Patient Data
Xray Right Foot:
There is severe midfoot arthropathy and joint destruction consistent with chronic charcot changes. There is lateral dislocation of the second to fifth tarsometatarsal joints and advanced arthropathy at the first tarsometatarsal joint which remains congruent. There is bony fragmentation and collapse of the mid foot with evolving rocker-bottom deformity. Surrounding soft tissue swelling is present.
Extensive arterial calcifications noted.
Case Discussion
Charcot or neuropathic joint is most commonly secondary to diabetes in Western society. Other causes however include long term steroid use, syringomyelia, tabes dorsalis and leprosy. Knee involvement should raise the possibility of tabes dorsalis, while calcification of the peripheral nerves (eg. common peroneal nerve) raises leprosy as the underlying causative factor.
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