An old woman with insulin dependent type 2 diabet mellitus and lower limb neuropathy presented to the emergency department with fever and erythema of the left foot.
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Periarticular generalized osseous destruction involving mid foot with reduced tarsometatarsal joint space and tarsal and metatarsal marrow edema with preservation of normal fat signal intensity in the subcutaneous tissue .
No associated sinus tracks, collections to suggest any secondary infection is seen in the midfoot region.
A skin ulcer is seen at the plantar surface of the first metatarsophalangeal joint.
The charcot neuroarthropathy is indistinguishable from the early stages of osteomyelitis. The clinical signs of inflammation should help the final diagnosis. Associated sinus track and disproportionately more soft tissue edema points towards active inflammation.