Charcot foot and ankle with osteomyelitis

Abstract

This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.

Acute Charcot foot and diabetes: A primer for the vascular nurse

“…Severe foot infection and concurrent CN carries a morbidity and mortality that can be as high as 35%, even when infection is managed appropriately. 5 Milne et al 6 cite a missed diagnosis of acute CN in 79% of cases with a delay in the correct diagnosis of up to 29 weeks; this delay is attributed to the rarity of the condition and lack of clinician education. Pakarinen et al 9 undertook a small study of patients living with chronic CN and found a statistically significant difference in functional outcome and walking distance when study patients were correctly diagnosed with the condition within 3 months of symptom onset versus those receiving a later diagnosis.…”

“…2,3,6,7 The condition is usually unilateral but the contralateral foot may be affected in up to 25%-30% of patients. 5,6,8 If pain is present in the affected foot it is usually mild or absent altogether, and on occasion, the patient may recall a preceding trauma to the foot. 2,5,6 An infrared dermal thermometer can be used to detect a >2.0 C temperature difference between the affected foot region in acute CN and the contralateral, unaffected foot in the same region.…”

“…5,6,8 If pain is present in the affected foot it is usually mild or absent altogether, and on occasion, the patient may recall a preceding trauma to the foot. 2,5,6 An infrared dermal thermometer can be used to detect a >2.0 C temperature difference between the affected foot region in acute CN and the contralateral, unaffected foot in the same region. 6 Sometimes, crepitus is palpated on foot examination.…”

“…6 These are absent in acute CN despite the marked foot swelling seen in the early stage of this condition. 5,6 Infections are commonly characterized by an entry wound and local erythema as opposed to acute CN which may have a more diffuse erythema and the absence of skin breakdown.…”

“…10 However, infection can reach bone through the blood stream or when local injury exposes bone to bacteria. 5 Several MRI features may help to distinguish acute CN from osteomyelitis. In osteomyelitis, the pattern of bone marrow edema tends to be localized to a single bone and be located in weight-bearing surfaces of the toe, metatarsal head, or calcaneus.…”