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Diabetic foot syndrome: Charcot arthropathy or osteomyelitis? Part I: Clinical picture and radiography

Aleksandra Konarzewska
Aleksandra Konarzewska
, 
Anna Korzon-Burakowska
Anna Korzon-Burakowska
, 
Ludomira Rzepecka-Wejs
Ludomira Rzepecka-Wejs
, 
Iwona Sudoł-Szopińska
Iwona Sudoł-Szopińska
, 
Edyta Szurowska
Edyta Szurowska
 y 
Michał Studniarek
Michał Studniarek
   | 30 mar 2018
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Article Category: review-article
Publicado en línea: 30 mar 2018
Páginas: 42 - 49
Recibido: 27 nov 2017
Aceptado: 22 ene 2018
DOI: https://doi.org/10.15557/jou.2018.0007
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© 2018 Aleksandra Konarzewska et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Patient with diabetic foot syndrome. Redness of the left foot and intensive edema in the active phase of Charcot arthropathy (courtesy of Dr. Anna Korzon-Burakowska, MD PhD)
Patient with diabetic foot syndrome. Redness of the left foot and intensive edema in the active phase of Charcot arthropathy (courtesy of Dr. Anna Korzon-Burakowska, MD PhD)

Fig. 2

Patient with diabetic foot syndrome. Typical deformity of the right foot with medial convexity resulting from bone destruction and dislocations in the course of Charcot arthropathy (courtesy of Dr. Anna Korzon-Burakowska, MD PhD)
Patient with diabetic foot syndrome. Typical deformity of the right foot with medial convexity resulting from bone destruction and dislocations in the course of Charcot arthropathy (courtesy of Dr. Anna Korzon-Burakowska, MD PhD)

Fig. 3

Radiographs in the dorsiplantar and oblique views. Soft tissue defect at the level of the 1st MTP joint. Osteopenia and blurred outline of the cortical layer of the head of the 1st metatarsal in the course of osteomyelitis
Radiographs in the dorsiplantar and oblique views. Soft tissue defect at the level of the 1st MTP joint. Osteopenia and blurred outline of the cortical layer of the head of the 1st metatarsal in the course of osteomyelitis

Fig. 4

Radiographs in the dorsiplantar and oblique views. Significant soft tissue edema of the 1st toe. Osteolysis of the distal phalanx of the first ray. Radiography is consistent with infection within the soft tissues and bone structures
Radiographs in the dorsiplantar and oblique views. Significant soft tissue edema of the 1st toe. Osteolysis of the distal phalanx of the first ray. Radiography is consistent with infection within the soft tissues and bone structures

Fig. 5

Radiographs of the calcaneus in lateral and axial views. Soft tissue defect as well as irregular and blurred outlines of the calcaneal tuberosity; abnormalities in the course of osteomyelitis
Radiographs of the calcaneus in lateral and axial views. Soft tissue defect as well as irregular and blurred outlines of the calcaneal tuberosity; abnormalities in the course of osteomyelitis

Fig. 6

Radiographs in the dorsiplantar and oblique views. Status post surgical amputation of the 5th ray through the distal fragment of the 5th metatarsal and of the distal 3rd–4th metatarsals. 2nd MTP joint subluxation. Blurred outlines of the 3rd and 4th metatarsal stumps in the course of osteomyelitis
Radiographs in the dorsiplantar and oblique views. Status post surgical amputation of the 5th ray through the distal fragment of the 5th metatarsal and of the distal 3rd–4th metatarsals. 2nd MTP joint subluxation. Blurred outlines of the 3rd and 4th metatarsal stumps in the course of osteomyelitis

Fig. 7

Radiograph in the dorsiplantar view. Bone destruction and numerous dislocations within the tarsal bones in the course of Charcot arthropathy
Radiograph in the dorsiplantar view. Bone destruction and numerous dislocations within the tarsal bones in the course of Charcot arthropathy

Fig. 8

Radiographs of the right foot in the dorsiplantar and oblique views. Status post surgical amputation of the first ray through the distal fragment of the 1st metatarsal. Thickening of the soft tissue shadow. Bone destruction and numerous dislocations within the tarsal bones in the course of Charcot arthropathy
Radiographs of the right foot in the dorsiplantar and oblique views. Status post surgical amputation of the first ray through the distal fragment of the 1st metatarsal. Thickening of the soft tissue shadow. Bone destruction and numerous dislocations within the tarsal bones in the course of Charcot arthropathy

Fig. 9

Radiographs in dorsiplantar and oblique views. Transverse osteolysis within the tarsal bones in the course of Charcot arthropathy
Radiographs in dorsiplantar and oblique views. Transverse osteolysis within the tarsal bones in the course of Charcot arthropathy

Fig. 10

Radiograph in the dorsiplantar view. Bone destruction and dislocations within the tarsal joints and tarsometatarsal joints of the left foot in the course of Charcot arthropathy
Radiograph in the dorsiplantar view. Bone destruction and dislocations within the tarsal joints and tarsometatarsal joints of the left foot in the course of Charcot arthropathy

Fig. 11

Radiograph of the calcaneus in the lateral view. Avulsion fracture of the calcaneal tuberosity. Soft tissue defect, blurred outlines of calcaneal bone fragments: Charcot arthropathy with concomitant osteomyelitis
Radiograph of the calcaneus in the lateral view. Avulsion fracture of the calcaneal tuberosity. Soft tissue defect, blurred outlines of calcaneal bone fragments: Charcot arthropathy with concomitant osteomyelitis

Fig. 12

Radiographs of the right foot in the dorsiplantar and oblique views. Bone destruction within the tarsal bones in the course of Charcot arthropathy. Osteolysis of forefoot bone structures in the course of osteomyelitis. Thickening of the soft tissue shadow. An example of concomitant osteomyelitis within the forefoot and Charcot arthropathy within the tarsal bones
Radiographs of the right foot in the dorsiplantar and oblique views. Bone destruction within the tarsal bones in the course of Charcot arthropathy. Osteolysis of forefoot bone structures in the course of osteomyelitis. Thickening of the soft tissue shadow. An example of concomitant osteomyelitis within the forefoot and Charcot arthropathy within the tarsal bones

Charcot arthropathy classification in terms of localization according to Sanders and Mrdjenovich(36)

Type Localization
Type 1 Involvement of the forefoot joints: interphalangeal and metatarsophalangeal joints
Type 2 Involvement of the tarsometatarsal joints
Type 3 Involvement of the cuneonavicular, talonavicular, and calcaneocuboid joints
Type 4 Involvement of the talocrural joint
Type 5 Involvement of the calcaneus
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