Neuropathic joint and diabetic myopathy

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Two weeks of foot swelling and redness, not responsive to antibiotics.

Patient Data

Age: 65 years
Gender: Female
This study is a stack
Sagittal
T2 fat sat
This study is a stack
Sagittal
T1
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Axial
T1
This study is a stack
Axial PD
fat sat
This study is a stack
Coronal T2
fat sat
This study is a stack
Coronal
T1
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Sagittal T1
C+ fat sat
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
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Info

Abnormality centred on the tarsometatarsal joint, where there is extensive subluxation without dislocation and arthropathic changes with disrupted joint spaces, subchondral oedema and enhancement with only mild low T1 bone marrow signal.

Extensive cutaneous and subcutaneous thickening, oedema and enhancement.

Intrinsic muscles of the foot demonstrate diffuse oedema and enhancement with relatively sparing of the lumbricals and interossei in the forefoot. No regions of non-enhancement to suggest necrosis. Less vivid oedema of the muscles in the visualised lower leg muscles.

Case Discussion

Findings are in keeping with a neuropathic (Charcot) joint noting chronically elevated HbA1c (10+ years in the poorly controlled or very poorly controlled range) results. In this setting, the muscle changes are in keeping with diabetic myopathy.

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