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Reminder of important clinical lesson
CASE REPORT
Acute hot foot: Charcot neuroarthropathy or osteomyelitis? Untangling a diagnostic web
  1. Louise Goldsmith1,
  2. Matthew Barlow2,
  3. Paul Jeffrey Evans3 and
  4. Upendram Srinivas-Shankar2
  1. 1 Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Diabetes and Endocinology, Arrowe Park Hospital, Wirral, UK
  3. 3 Department of Radiology, Arrowe Park Hospital, Wirral, UK
  1. Correspondence to Louise Goldsmith, louisegoldsmith{at}doctors.org.uk

Abstract

A 55-year-old man with poorly controlled type 1 diabetes with microvascular and macrovascular complications presented with a 1-week history of painful erythematous swelling on the dorsum of the left foot with two areas of foot ulceration. Inflammatory markers were raised. MRI of the left foot revealed a soft tissue swelling on the dorsum of the left foot, marrow oedema and destruction of several small joints of the foot, indicating osteomyelitis and Charcot neuroarthropathy (CN). The soft tissue swelling on the dorsum of the left foot was debrided; per-operatively bone destruction of base of the fifth metatarsal was found. The patient received intravenous antibiotics for 6 weeks. The clinical features of CN including erythema, oedema and elevated temperature of the left foot settled with off-loading the foot in an air cast walker after 6 months. Our case highlights the need to recognise CN in an acutely inflamed foot of diabetic patients with neuropathy, even when other conditions like soft tissue infection and osteomyelitis can explain the clinical features.

  • diabetes
  • bone and joint infections
  • peripheral nerve disease
  • orthopaedics

https://doi.org/10.1136/bcr-2018-228597

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    Footnotes

    • Contributors All authors substantially contributed to the data gathering, interpretation formation and final review of the manuscript. And assisted in the literature review. LG specifically compiled the initial and final drafts. MB contributed to the initial concept, data gathering and processing. PJE specifically assisted in selection, editing and labelling of images. US-S assisted in conceiving the idea, formulating the manuscript plan, editing and literature review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.