Relapse of Charcots osteoarthropathy or infection

A 60-year-old type 1 diabetic of 42 years' duration who had bilateral Charcot's osteoarthropathy affecting both feet and 12 years' previous history of ulcers and infections, was referred to the foot clinic with a hot, swollen left ankle and erythema over the medial malleolus. Both her feet were intact. The left foot was very painful on weightbearing. A provisional diagnosis of infection was made although we could not be sure that this was not a relapse of Charcot's osteoarthropathy. She was given intravenous vancomycin 1 g bd, ceftazidime 1 g tds, metronidazole 500 mg tds and oral fucidin 500 mg tds as she had recently had an MRSA infection. The ankle initially appeared to settle, but after 3 days she developed severe pain in the left foot and ankle at rest, with a fever of 39°C and rigors. She went to theatre and an abscess communicating with the subtalar joint was drained. A swab showed pus cells but no growth. She healed in 4 months, but came back to the foot clinic again with a severely infected toe on her other foot after 2 weeks.

Key points

• Patients with Charcot's osteoarthropathy can occasionally relapse with increased swelling and warmth of the involved foot

• It is difficult to distinguish between relapsed Charcot's osteoarthropathy and infection in an intact foot

• Clinical progress needs to be closely monitored with daily review for specific signs of infection.

Diabetes Sustenance

Diabetes Sustenance

Get All The Support And Guidance You Need To Be A Success At Dealing With Diabetes The Healthy Way. This Book Is One Of The Most Valuable Resources In The World When It Comes To Learning How Nutritional Supplements Can Control Sugar Levels.

Get My Free Ebook

Post a comment