Charcot neuroarthropathy versus osteomyelitis: a case series

Area of Science:

• Podiatry
• Diabetology
• Orthopedics

Background:

• Diabetic patients with peripheral neuropathy face a 25% risk of foot ulcers.
• Foot ulcers can progress to severe soft tissue infections and osteomyelitis.
• Charcot neuroarthropathy shares symptoms with osteomyelitis but is less common and often misdiagnosed.

Purpose of the Study:

• To highlight the diagnostic challenges between Charcot neuroarthropathy and osteomyelitis in diabetic foot ulcers.
• To present a case series demonstrating successful conservative management of Charcot neuroarthropathy.
• To emphasize the importance of differentiating these conditions for appropriate wound management.

Main Methods:

• Case report of three patients with diabetes, neuropathy, and foot ulcers.
• Patients underwent prophylactic surgery, followed by post-operative swelling and radiographic concerns for osteomyelitis.
• Diagnosis of Charcot neuroarthropathy was maintained, and treatment involved immobilization and offloading.

Main Results:

• All three patients experienced resolution of foot fragmentations.
• Treatment with immobilization and offloading was successful in all cases.
• No antibiotics or further surgery were required for resolution.

Conclusions:

• Charcot neuroarthropathy and osteomyelitis present with similar clinical signs and symptoms.
• Distinguishing between Charcot neuroarthropathy and osteomyelitis is crucial for effective wound care in diabetic patients.
• Conservative management, including immobilization and offloading, can be effective for Charcot neuroarthropathy, avoiding unnecessary antibiotic or surgical interventions.