There is unilateral erythema and oedema (Fig. 3.15). The foot is at least 2°C hotter than the contralateral foot and the difference may be as great as 10°C. This may be measured with an infrared skin thermometer. There may be a history of minor trauma such as tripping, twisting the ankle or walking over rough surfaces such as cobbles. Charcot's osteoarthropathy may follow injudicious mobilization after surgery, a period of bed rest or casting.
About 30% of patients complain of pain or discomfort. Rarely, pain may be very severe.
X-ray at this time may be normal. However, a technetium MDP bone scan will detect early evidence of bony destruction (Fig. 3.16). Early diagnosis is essential.
Patients awaiting bone scan should be treated as if the diagnosis has been confirmed. Although patients with an
Fig. 3.15 Unilateral oedema and erythema in acute onset Charcot's osteoarthropathy.
early injury may appear to be developing Charcot's osteoarthropathy, it is not possible yet to differentiate between those who have a soft tissue injury only and those who will develop extensive bony destruction. For this reason, all patients in stage 2 with a history of trauma, redness, warmth and oedema should be treated with a total-
contact cast, which is described in full in Chapter 4. If the problem is not a Charcot's osteoarthropathy, but a simple sprain, it will resolve rapidly.
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