Diabetic Foot For Radiologist
An elderly diabetic lady presents with painful and swollen foot. Resident-Professor series by Dr MGK Murthy & Dr Sumer Sethi
(a)What do the X rays show ?
They show subluxations, lucencies or bones, irregularity, periosteal reaction, and Soft tissue swelling
(b)What are the possibilities ?
The possibilities are Charcot’s arthropathy and osteomyelitis in diabetes
In this case presence of ulcer, lucencies, and no fragmentation or dislocation support osteomyelitis
(c ) How do we differentiate ?
It is big clinical dilemma as both present with hot swollen foot in diabetes. Usually infection always reaches the bones via skin ulcer and the presence or absence of the same is vital . Increased Blood counts and C Reactive protein positivity, absence of bilaterality help further. Presence of fragmentation and dislocations suggest Charcots. Charcots being autonomic neuropathy presents with fragmentations, fractures, sclerosis, and subluxations
(d)What is the etiology of charcots?
Not known exactly . However some believe sensory neuropathy contributes by ulceration not noticed by the patient (neurotraumatic theory) and other autonomic neuropathy leading to increased blood flow and thereby the mismatch between bone synthesis and destruction
Diabetic Foot For Radiologist Reviewed by Sumer Sethi on Sunday, October 09, 2011 Rating: