Charcot foot (neuropathic arthropathy)


Physical Exam




ITE 2012, Q 173. A 49-year-old female with type 1 diabetes mellitus presents to your office with a 1-week history of a red, hot, swollen foot. She recalls twisting her ankle when stepping off a curb the day before the swelling began. She denies fever or significant pain. She has difficulty walking due to stiffness in the foot. On examination you find the patient is in no distress. Her temperature is 36.7°C (98.1°F), blood pressure 144/82 mm Hg, and heart rate 80 beats/min. Her right foot is edematous, erythematous, and excessively warm. Monofilament testing reveals significant impairment of sensation of both feet. She has restricted range of motion of the right ankle and foot compared to the left. No skin lesions are present. Dorsalis pedis pulses are brisk and symmetric. A radiograph of the right foot is normal.

Laboratory Findings
Hemoglobin A1c = 8.2%
Capillary blood glucose = 213 mg/dL
Hematocrit = 37.2% (N 36.0–46.0)
WBCs  =  11,000/mm3 (N 4300–10,800)
Platelets  =  350,000/mm3 (N 150,000–350,000)
Erythrocyte sedimentation rate  =  30 mm/hr (N 1–25)

Which one of the following is the most likely diagnosis?
A) Osteomyelitis
B) Osteoarthritis
C) Acute gout
D) Charcot foot

Answer: A