Abstract
Charcot neuropathic osteoarthropathy (CN) or Charcot foot poses a significant challenge in clinical practice. A high clinical suspicion is needed to recognise the early presentation.
The active CN presents with inflammation (redness, swelling, heat, dull ache/discomfort and loss of function). Bedside tests include assessment of neuropathy, blood supply and measurement of skin foot temperature.
The diagnosis is primarily based on clinical findings and imaging, as at present, there are no established biochemical disease markers. In the active Charcot foot, a normal to slight increase in the serum C-reactive protein levels and normal white cell count have been reported. Foot and ankle radiographs are the first line investigation. When patients present early in the acute active phase, weight-bearing foot and ankle radiographs may not be indicative of any bone and joint damage. Further imaging investigations (a technetium methylene diphosphonate bone scan or single-photon emission computed tomography/computed tomography (SPECT/CT) bone scan as well as magnetic resonance imaging (MRI) of the foot have been recommended in the diagnosis of a stage 0 Charcot foot (X-ray negative stage).
Patients with suspected CN should be promptly offloaded with a below knee cast as timely management can arrest the osteoarthropathy and maintain the X-rays normal. If not recognised and managed at this stage, extensive irreversible bone and joint destruction can occur with risk of foot deformity, ulceration and amputation. Interdisciplinary approach is key in managing CN in diabetes.
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Petrova, N.L. et al. (2019). Charcot Foot: Investigations. In: Edmonds, M., Sumpio, B. (eds) Limb Salvage of the Diabetic Foot. Springer, Cham. https://doi.org/10.1007/978-3-319-17918-6_12
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DOI: https://doi.org/10.1007/978-3-319-17918-6_12
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