Charcot Joint Case Study

Diagnosis:

Diagnosis of acute Charcot joint or neuropathy is quite difficult, clinical suspicion is highly important. Infection is the primary differential diagnosis, most prominently either cellulitis or osteomyelitis. Imaging and examination are used to find out if there is infection; if not, then the diagnosis would most likely be Charcot joint. Clinical image such as a warm, edematous, erythematous joint with intact pulses in the absence of infection is Charcot foot until proven otherwise. If edema and erythema disappear with 5-10 minutes of leg rising in the supine patient, it is suggestive of Neuropathy. On the other hand, persistence of these findings is a signal of infection. In which it usually occurs through the invasion and skin breakdown. There are some similarities between infection and Charcot joint such as, leukocytosis, fever, and hyper sedimentation. Systemic signs and symptoms or ulceration are more suggestive but not diagnostic of infection, and co-occurrence has been described in 16% of diabetics with ulcer. To evaluate acute CN, thermal evaluation is important because the affected foot temperature is 2°C warm more than the other foot. In some clinics they use infrared dermal thermometry to measure skin temperature.

Radiology:

In chronic charcot foot, changes in radiography are divided into two main types, hypertrophic and atrophic. Hypertrophic joints are found mostly in the small joints of the foot, characterized by joint dislocation, subluxation, bone fractures, calcification of soft tissues and sclerosis. Bone fractures characterizes the hypertrophic changes. In the upper tip, atrophic type is more common and characterized by bone resorption. In one study, radiographic bony cortical disruption with direct spread from infected ulcer or cellulitis aided in the diagnosis of osteomyelitis.