Charcot foot

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Left foot swelling, and abnormal gait

Patient Data

Age: 60 years
Gender: Female

Left foot

x-ray

Malalignment of tarsal bones with irregular margins and increased bone density with resultant flattening of plantar arch. Disorganized intertarsal joints with widening of tibiotalar and talocalcaneal joint spaces. Intertarsal osteoarthritic changes are noted, with marginal osteophytes.

Inferior calcaneal bone spur is noted.

Diffuse soft tissue calcifications of the lower leg.

Case Discussion

Findings are consistent with Charcot foot, secondary to chronic diabetic neuropathy which affects the intertarsal joints resulting in joint disorganization, dislocation and destruction.

Mnemonic of Charcot joint (6 Ds)

  • dense bones (subchondral sclerosis)
  • degeneration 
  • destruction of articular cartilage
  • deformity
  • debris (loose bodies)
  • dislocation

Diffuse soft tissue calcifications of the lower leg are one of the complications of chronic uncontrolled diabetes Mellitus, which can mimic changes of chronic venous insufficiency or scleroderma (calcinosis circumscripta) 1.

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