Midfoot and Hindfoot Bone Marrow Edema Identified By Magnetic Resonance Imaging in Feet of Subjects With Diabetes and Neuropathic Ulceration Is Common but of Unknown Clinical Significance

Thorning, Chandani; Gedroyc, Wladyslaw; Tyler, Philippa; Dick, Elizabeth; Hui, Elaine; Valabhji, Jonathan

doi:10.2337/dc10-0037

Cited by 21 publications

(13 citation statements)

References 7 publications

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“…MRI features of Charcot's foot stage 0 (in insensitive feet of patients with diabetic neuropathy) were demonstrated previously: subchondral ("traumatic") bone marrow edema, occasionally triggering neuro-osteoarthropathy (Charcot's foot stage I-III) [11-13,18]. In this condition, bone marrow edema is believed to indicate bone or joint contusion, osteitis, or stress-induced trabecular microfracture [14-16,18,19], respectively.…”

Section: Discussionmentioning

confidence: 82%

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Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

Poll

Weber

Böhm

et al. 2010

Diabetol Metab Syndr

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BackgroundThe diagnosis of Sudeck's syndrome stage 1 (nowadays termed complex regional pain syndrome I, abbreviated CRPS I) is based on clinical features, namely swelling and pain in a limb. Plain X-ray may be normal. In the absence of pain sensitivity, e.g. in diabetic neuropathy, CRPS I of the foot can be mistaken for Charcot's foot stage 0 (so-called neuro-osteoarthropathy).Case presentationThe case of a type-1 diabetic woman is reported, in whom CRPS I following a calcaneal fracture was mistaken for Charcot's osteoarthropathy (because of bone marrow edema displayed by conventional MR imaging). In addition, a review is presented on 6 consecutive cases with CRPS I of the foot, and on 20 cases with Charcot's foot stage 0, with particular emphasis on MR imaging findings. The number of bones per foot affected with marrow edema was similar in either condition, with a tendency towards a more patchy, diffuse distribution of bone marrow edema in CRPS I. Bone marrow edema apparently regressed more promptly in response to treatment in Charcot's foot stage 0.ConclusionDifferentiation of CRPS I from Charcot's foot stage 0 remains a diagnostic dilemma in patients with pain insensitivity. Conventional MRI may be helpful, when repeated for monitoring the treatment response.

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Section: Discussionmentioning

confidence: 82%

“…In this condition, bone marrow edema is believed to indicate bone or joint contusion, osteitis, or stress-induced trabecular microfracture [14-16,18,19], respectively.…”

Section: Discussionmentioning

confidence: 99%

Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

Poll

Weber

Böhm

et al. 2010

Diabetol Metab Syndr

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“…Previously, Thorning et al [41] had noticed comparable spotty bone marrow edema in feet with neuropathic foot ulcerations during offloading with appropriate orthoses. This pattern of EESC might not predict future Charcot osteoarthropathy, and is more common in end-stage renal disease, they suggested [41]. However, we were unable to underpin their assumptions by our small study.…”

Section: Discussionmentioning

confidence: 99%

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Chantelau

Antoniou

Zweck

et al. 2018

Diabetic Foot & Ankle

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Background: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. Study design: Retrospective observational study, chart review Material and methods: Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment. Only cases without concomitant infection or skin ulcer were chosen, in whom both was documented, onset of symptomatic foot swelling and patient compliance with cast treatment. Results: From 1994 to 2017, 45 consecutive cases in 37 patients were retrieved, with 95 MRI follow-up studies (1–6 per case, average interval between studies 13 weeks). Decreasing EESC was documented in 66/95 (69%) follow-up studies. However, 29/95 (31%) studies revealed temporarily increasing, migrating or stagnating EESC. Conclusion: EESC on MRI disappear in response to prolonged offloading and immobilizing treatment; however, physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images. Conventional MRI is useful for surveillance of active-stage Charcot foot recovery.

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“…However, MRI demonstrated bone marrow oedema in midfoot and hindfoot areas in 30% of the patients with neuropathic diabetic ulceration and did not predict future CN or osteomyelitis; this type of bone marrow oedema was more common in ESRD (7, 18). According to Valabhji and our brief experience, clinicians should be aware that Charcot can present post-transplantation without the cardinal clinical signs but still lead to deformity (7).…”

Section: Discussionmentioning

confidence: 86%

Charcot neuroarthropathy in simultaneous kidney–pancreas transplantation: report of two cases

Vecchio

Raimondi

Rivarola

et al. 2013

Diabetic Foot & Ankle

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Charcot neuroarthropathy (CN) is considered a major complication in diabetes mellitus (DM), and it is estimated that 1% of diabetic patients may develop this complication. Simultaneous kidney–pancreas transplantation (SKPT) is one of the most effective therapies for patients with type 1 DM and end-stage diabetic nephropathy. Some cases with a Charcot-modified clinical presentation during the postoperative convalescence period after SKPT have been described. The clinical presentation may condition severe destructive lesions, and good practices include systematic follow-up. Based on the cases described, SKPT is one more entity that might lead to CN ‘foot-at-risk’. The aim of this article is to describe two cases of neuropathic arthropathy with rapid progression in the short term after SKPT.

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Midfoot and Hindfoot Bone Marrow Edema Identified By Magnetic Resonance Imaging in Feet of Subjects With Diabetes and Neuropathic Ulceration Is Common but of Unknown Clinical Significance

Cited by 21 publications

References 7 publications

Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Charcot neuroarthropathy in simultaneous kidney–pancreas transplantation: report of two cases

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