Neuro-osteoarthropathy of the Foot—Radiologist: Friend or Foe?

Abstract

Charcot neuro-osteoarthropathy is a significant problem with a rapid devastating nature. If not recognized it may lead to progressive foot deformity, ulceration or osteomyelitis, or eventually to amputation. The diagnosis is challenging, and imaging plays a pivotal role. Rapid and accurate diagnosis and early intervention is important to prevent progressive and destructive Charcot deformity of the foot. The imaging workup of the warm swollen Charcot foot is presented. The advantages and disadvantages of different imaging modalities are discussed. This review provides the consulting radiologists with tools to cautiously differentiate Charcot's neuro-osteoarthropathy from osteomyelitis. It is crucial to look beyond radiological features and integrate the location of pathology and presence of ulcer in the reading process. Because imaging plays a pivotal role in arriving at the definitive diagnosis and adequate treatment, the radiologist "makes the difference"-can be a friend or a foe.

What the radiologist needs to know about Charcot foot

“…Those with the classic rocker‐bottom foot, a severe chronic deformity typical in this condition may have excessive callus formation, a plantar ulcer or a pre‐ulcer under a focal point of plantar pressure . Foot ulceration may eventually lead to infection, such as cellulitis and OM, and amputation …”

“…This imaging technique is well suited to demonstrating characteristic altered bone marrow signal – suggestive of acute CN in the appropriate clinical setting . In Stage 0 of Charcot neuroarthropathy, MRI typically reveals subchondral bone marrow oedema with or without microfracture . In later stages of acute Charcot neuroarthropathy, swelling of soft tissue and muscles, and bone marrow oedema become evident .…”

“…Charcot neuropathic osteoarthropathy (CN) is a progressive disease affecting the bones, joints and soft tissue of the foot and ankle, most commonly associated with diabetic peripheral neuropathy. Delay in the diagnosis of CN can lead to disruption of the bony architecture of the foot, deformity, recurrent foot ulceration, cellulitis, osteomyelitis (OM) and, ultimately, amputation . Furthermore, patients with diabetes complicated by Charcot foot have especially high morbidity, frequency of hospitalisation and therefore, significant utilisation of expensive medical resources .…”

Charcot Neuro-Osteoarthropathy

“…The radiological description is according to the five D's: bone density, joint distention, bony debris, joint disorganization and dislocation of the joint [2].…”

“…It is defined by painful or relatively painless bone and joint destruction and deformity in limbs that have lost sensory innervation, it commonly develops in the mid-foot but also in the forefoot and hind foot [1]. The estimated prevalence in diabetic population is between 0,1% and 7,5% [2]. Due to the rapid severe and irreversible foot deformity, recognition of acute CN is extremely important.…”