Volume 77, Number 9

Charcot neuroarthropathy:
An often overlooked complication of diabetes

1. A 50-year-old woman jogger with a long history of diabetes mellitus complicated by peripheral neuropathy presents with swelling and redness in her left foot of 1 month’s duration. She does not recall any trauma to her foot. She finds it painful to stand and presents in a wheelchair. No trauma to the feet is appreciated on examination, but her left foot is warm, erythematous, and swollen. She is transferred to a gurney and taken to radiology, where radiographs of her foot and ankle are taken with her in the supine position. No abnormalities are appreciated on these images. Laboratory studies show a normal white blood cell count. Which of the following statements about this patient’s condition is most accurate?

1. The normal x-rays of her foot are not consistent with a diagnosis of Charcot neuroarthropathy
2. Her pain makes Charcot neuroarthropathy unlikely and is probably indicative of infection
3. The absence of a wound on her foot makes infection unlikely
4. She should undergo positron emission tomography-computed tomography (PET-CT) to rule out osteomyelitis
5. Her condition results from unfelt trauma to the foot during jogging and delayed healing due to poor circulation