Acute Charcots osteoarthropathy of the forefoot

A 21-year-old woman with type 1 diabetes of 15 years' duration developed painless swelling of both forefeet (Fig. 3.20a). There was no evidence of ulceration. X-ray revealed fragmentation and lucency of the 2nd, 3rd and 4th metatarsal heads of both feet (Fig. 3.20b). The patient was supplied with a wheelchair and underwent strict non-weightbearing for 4 weeks. The oedema gradually resolved. Deformity did not develop and the radiological changes stabilized.

Keypoints

• The radiological changes of osteonecrosis are typical of forefoot osteoarthropathy in the absence of foot ulceration and sepsis when sucked sugar candy appearances maybe noted

• Charcot's osteoarthropathy may present spontaneously with no history of trauma

Fig. 3.20 (a) Swelling of the forefeet, (b) X-ray of both feet showing fragmentation and lucency of the 2nd, 3rd and 4th metatarsal heads.
Midfoot Breakdown
Fig. 3.21 Medial convexity of mid-foot developing after amputation of 1st toe.

• Young type 1 diabetic women are known to have osteopenia and are susceptible to fractures, including foot fractures.

Fig. 3.22 Rockerbottom deformity of the mid-foot with early breakdown.

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