Endocrine Abstracts

Introduction: Charcot neuroartropathy (CN) is a devastating complication of diabetes rapidly leading to irreversible foot deformity when misdiagnosed. Differential diagnosis with foot infections and other foot-related diseases remains challenging.

Case: A 58-year-old woman with type 2 diabetes was hospitalised with a red, swollen left leg and high fever. The diagnosis of erysipelas with a neuropathic wound of the first digit as the entry wound was established. After antibiotic treatment, the infection abated and the patient was discharged. Twelve days later she visited the Emergency Department with increased swelling and pain of the left leg, residual redness and a new skin defect on the left second toe. Ten days later, she was seen at the diabetic foot clinic. The patient reported a recent trauma, which had resulted in pain and a swollen, red right foot. X-rays and a bone scintigraphy with SPECT–CT were performed and surprisingly suggested CN of both feet, a finding that was later confirmed by MRI. A clinically suspected osteomyelitis of the left second digit was ruled out with a leucocyte scan and SPECT–CT. Immobilisation for 3 months with bilateral total contact casts (TCC) was deemed impracticable, so the left foot was treated with an aircast walker instead. Clinically the inflammatory signs subsided but bilateral talar oedema remained noticeable on MRI. Bilateral aircast walkers were advised for another 2 months until custom-made shoes became available.

Conclusion: The diagnosis of an active Charcot foot remains challenging, especially after previous infection or trauma which both may trigger CN. Bilateral CN, although extremely rare, further complicates early diagnosis and efficient bilateral offloading.