Charcot foot in diabetes mellitus: Ten things a radiologist needs to know
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Publication: Journal of Medical Imaging and Radiation Oncology
Start Page: 142
Learning objectives: To explain ten key imaging features of the initial stages and later complications of Charcot neuropathic osteoarthropathy (CN). Furthermore, to emphasise the importance of the radiologist within a multidisciplinary team in facilitating early diagnosis and expediting management of this potentially devastating disease. Background: CN is a progressive disease affecting the bones, joints and soft tissue of the foot and ankle, most commonly associated with diabetic neuropathy. Patients with diabetes complicated by CN have especially high morbidity, frequency of hospitalisation, and therefore, significant utilisation of expensive medical resources.1 Early diagnosis and intervention are essential to the prevention of debilitating structural deformities of the foot in CN patients. The diagnosis of Charcot foot can be challenging, especially in the initial stages of the disease process, and is based on clinical presentation supported by various imaging modalities.2 Imaging findings: The most widely accepted classification is the Eichenholtz staging system, which encompasses the sequence of changes in the Charcot foot on plain x-ray and includes Stages 1 to 3.3 Stage 0, proposed by Shibata and colleagues, is characterised clinically by erythema, oedema, and heat but no obvious abnormalities on x-ray.4 Diagnosis of Stage 0 with MRI followed by early treatment may prove to be critical in preventing progression to debilitating subsequent stages.5 In the established phase of the disease, CN should not be considered a radiological curiosity as there are several important complications that may be detectable. Conclusion: Imaging can be crucial for detection of early CN and is useful in monitoring progression and complications. The later stages of this disease are potentially devastating for individuals and present an ongoing socio-economic challenge for health systems around the world. The astute radiologist, particularly in the context of a multidisciplinary team, plays a critical role in diagnosis of the primary disease and its complications.