Practice Easily Missed?

Acute Charcot foot

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1397 (Published 14 March 2012) Cite this as: BMJ 2012;344:e1397
  1. Piero Baglioni, physician in endocrinology and diabetes1,
  2. Manzar Malik, consultant radiologist2,
  3. Onyebuchi E Okosieme, consultant physician in endocrinology and diabetes1
  1. 1Department of Endocrinology and Diabetes, Prince Charles Hospital, Cwm Taf Local Health Board, Merthyr Tydfil CF47 9DT, UK
  2. 2Department of Radiology, Prince Charles Hospital
  1. Correspondence to: O E Okosieme Onyebuchi.Okosieme{at}Wales.nhs.uk

Key points

  • Suspect acute Charcot foot in a patient with diabetes and neuropathy who presents with a swollen warm foot

  • If acute Charcot foot is suspected, arrange for offloading of the foot (to minimise further damage) and refer to a specialist foot clinic immediately

  • Plain radiographs may be normal in the early stages of the disease

  • Magnetic resonance imaging should be considered when the suspicion of acute Charcot foot is high

A 38 year old man was referred by his general practitioner to our diabetes foot clinic with a swollen red foot (fig 1). He had had type 1 diabetes for 25 years, complicated with retinopathy, peripheral neuropathy, and nephropathy, and was being worked up for dialysis following a failed pancreas-kidney transplant. The absence of pain together with preserved pulses and intact skin raised a suspicion of acute Charcot foot. A plain radiograph of the foot showed fractures through the necks of the first three metatarsals (fig 2). We offloaded the foot in a total contact cast and advised the patient to limit weight bearing. Magnetic resonance imaging (MRI) subsequently confirmed neuroarthropathic changes of acute Charcot (fig 3).

Fig 1 Acute Charcot foot

Fig 2 Plain radiograph of the foot showing fractures through the necks of the first three metatarsals

Fig 3 Axial T1 weighted MRI showing pathological fractures through the necks of the first three metatarsals (arrows) with oedema in metatarsal shafts and lateral cuneiform bones (arrow heads). These features, in a patient with diabetes and no history of trauma, suggest acute Charcot foot

What is acute Charcot foot?

Charcot’s neuroarthropathy is a destructive process of bone and joint, typically seen in a foot that …

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