foot ankle
Charcot Neuroarthropathy
advanced
6 min
28 marks
6 questions
Clinical Scenario
A 62-year-old male with Type 2 diabetes mellitus of 18 years duration and diabetic peripheral neuropathy presents with a swollen, warm right foot for 6 weeks. He denies significant trauma but recalls "twisting" his ankle while gardening. He has no pain but reports difficulty fitting into his shoe. His diabetes is poorly controlled (HbA1c 9.2%). Clinical examination reveals a diffusely swollen, warm (3°C warmer than contralateral) right midfoot with palpable bony prominences plantar-medially. Sensation is absent to monofilament testing. Pedal pulses are palpable. There is no break in the skin.
Weight-bearing radiographs are provided.
Weight-bearing radiographs are provided.
Clinical image for Charcot Neuroarthropathy
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
What is Charcot neuroarthropathy? Describe the pathophysiology and theories behind this condition.
Question 2 (5 marks)
How would you classify Charcot neuroarthropathy? Describe both anatomical and clinical staging systems.
Question 3 (6 marks)
Describe your assessment of this patient. What investigations would you order and how would you interpret them?
Question 4 (5 marks)
Outline your management approach for this patient in the acute phase. What is the role of total contact casting?
Question 5 (4 marks)
When is surgical intervention indicated? What are the principles of surgical reconstruction?
Question 6 (4 marks)
What are the complications of Charcot foot and how would you manage ulceration in this context?