Medical Imaging in Differentiating the Diabetic Charcot Foot from Osteomyelitis

Medical Imaging and Laboratory Analysis of Diagnostic Accuracy in 107 Consecutive Hospitalized Patients With Diabetic Foot Osteomyelitis and Partial Foot Amputations

“…9 Furthermore, radiographical changes of osteomyelitis can be mistaken for other diagnoses such as Charcot neuroarthropathy. 21 In our study, when the final reduced model was based on the plain radiographic findings (with and without considering the MRI findings), it was found that with positive radiographic findings, diabetic foot osteomyelitis was more likely (odds ratio = 5.2291; P = .0253). Because our study was entirely based on hospitalized patients with partial foot amputations, the diabetic foot infections were likely more severe than those found in studies of outpatient cases.…”

Case series on the Charcot neuroarthropathy in hands after cervical central cord syndrome

“…X-ray in middle stage can show the degenerative change of the involved joint, then obliteration of joint space, fragmentation of both articular surfaces of the joint leading to subluxation or dislocation, scattered “chunks” of bone in fibrous tissue, joint distention by fluid, surrounding soft tissue edema and heterotopic ossification can develop. When plain radiographs do not show any initial signs of osseous fragmentation or dislocation in spite of clinical suspicion, other imaging methods, including magnetic resonance imaging (MRI), computed tomography, and bone scintigraphy, may support the diagnosis [ 14 ]. E.g., at stage 0, soft tissue edema and subchondral bone marrow edema may be found with MRI.…”

What Is the Best Method to Differentiate Acute Charcot Foot From Acute Infection?

“…1 In terms of other physical features, CN typically affects the midfoot and lacks associated skin breakage, whereas OM is more frequently found in the forefoot and is often accompanied by soft tissue infection or ulcer. 23,39 Additionally, although it is possible to contract OM through hematogenous spread, the vast majority of cases are spread directly via a soft tissue infection or ulcer. A wound size >4.5 cm 2 is associated with a 3 times higher chance of underlying OM.…”

“…11 Radiographic signs of infection, such as demineralization, periosteal reaction, and cortical destruction, may not appear until 2 to 3 weeks after onset and require a loss of 40% to 50% bone mass to detect the difference. 18,39 The accuracy of plain radiography for early diagnosis is 50% to 60% with a sensitivity of 60% and a specificity of 80%. 25,37 Therefore, more advanced imaging is needed for a diagnosis of acute osteomyelitis.…”