Differential diagnosis of diabetic neuroosteoarthropathy and osteomyelitis using medical imaging techniques

Abstract

According to modern concepts, Charcot’s neuro-osteoarthropathy (Charcot’s foot) is considered as an aseptic inflammatory process in individuals with distal polyneuropathy, which leads to damage to bones and joints. Most often, Charcot’s foot is formed in patients with diabetes mellitus (DM) and affects the foot and ankle joint. Diabetic neuroosteoarthropathy (DNOAP) is divided into active and inactive stages. The typical clinical picture of the active stage of diabetic neuroosteoarthropathy is edema and hyperemia of the affected foot, with a temperature gradient of more than 2 °C compared with an unaffected foot. The nonspecific clinical picture of the active stage of diabetic neuroosteoarthropathy makes it difficult to diagnose and often leads to the need for differential diagnosis of the active stage of diabetic neuroosteoarthropathy and osteomyelitis, which is one of the most difficult issues in clinical practice. Early detection of these conditions is crucial, since treatment of the active stage of diabetic neuroosteoarthropathy can prevent irreversible deformity of the foot, and detection of osteomyelitis will allow timely antibiotic therapy. Signs of changes in bone and foot structures in the active stage of diabetic neuroosteoarthropathy in images obtained by computer X-ray, magnetic resonance and emission tomography may be similar to signs of osteomyelitis, which determines the importance of choosing an imaging method when examining a patient and developing an effective algorithm for early diagnosis of DNOAP. In this review, the main attention will be paid to the distinctive features of the active stage of diabetic neuroosteoarthropathy and osteomyelitis when using imaging research methods.