Charcot joint

Case contributed by Gerry Gardner

Presentation

Presented 2 months after stepping on pin. Swollen, red foot Patient is diabetic. 20 year history of foot injury with no treatment at the time

Patient Data

Age: 60
Gender: Male
Modality: X-ray

2nd metatarsal fracture with surrounding sclerosis. 

Modality: MRI

There is a fracture dislocation of the proximal aspect of the second metatarsal with associated extensive callus formation. There is generalised bone marrow oedema throughout the cuneiform, cuboid, navicular and metatarsal bones. There is patchy oedema in the talus and to a lesser extent the calcaneus.

There is phlegmonous soft tissue swelling and oedema throughout the midfoot. There is moderate to marked tenosynovitis of the anterior compartment tendons. I do not identify a discrete soft tissue abscess or a definite sinus tract from skin to bone.

There is a mild joint effusion at the first MTP joint but there is no subchondral oedema on either side of the articulation.

Case Discussion

All of the features seen could be attributed to a neuropathic Charcot type deformity but it is difficult to exclude superimposed infection given the degree of bone marrow oedema.

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Case Information

rID: 14087
Case created: 23rd Jun 2011
Last edited: 30th Sep 2015
Inclusion in quiz mode: Included

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