Once the foot becomes deformed or shows X-ray changes, it has entered the bony destructive phase. Clinical signs are swelling, warmth, a temperature 2°C greater than the contralateral foot and deformities which can
present in the forefoot, mid-foot, hindfoot and ankle. An early sign on X-ray is widening of the space between the bases of the 1st and 2nd metatarsals (Fig. 3.18) Advanced changes show fragmentation, fracture, new bone formation, subluxation and dislocation. These changes often develop very rapidly, within a few weeks of the onset, and sometimes within a few days.
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