Endocrine Abstracts

Introduction: Charcot’s foot is a rare and extremely serious complication of diabetic neuropathy resulting in foot deformities through the non-infectious destruction of bones and joints. Its diagnosis is very difficult, it is often evoked in front of the persistence of inflammatory signs in spite of a well conducted antibiotic therapy.

Case report: 59-year-old patient, T2DM for 3 years on Metformin, active smoker for 20 years. Reports for 1 week the progressive installation of a red and painful swelling of the dorsal surface of the right foot without any notion of obvious trauma or signs of infection.

Clinical examination: Overweight patient with a BMI of 26 kg/m². On the right foot, hot and painful red tumefaction on the dorsal side of the foot, without ulceration, without pus or serum. Disturbed monofilament test without other neurological signs, on mixed feet with neuropathic predominance classified as stage 2-IWGDF and stage 0A-TEXAS, with perceived and symmetrical pulses, an SPI at 0.9.

Paraclinical findings: Glycemia: 1.43 g/l Urine dipstick: Negative

CRP: 213 mg/l (<6) Procalcitonin: 0.19 ng/ml (0.5)

Uricemia: 67 (35-72) mg/l GFR = 78 ml/min HbA1c: 7.8%

X-rays of the right foot (F/P): No osteitis.

MRI of the right foot: osteoarthropathy without bone lysis associated with tendinosynovitis.

The patient benefited from a total discharge by removable boot and alendronic acid at a rate of 70 mg/week for 6 months and diabetes balance with a good evolution.

Conclusion: The management of Charcot’s foot remains complex and often requires multidisciplinary management. The use of bisphosphonates in the control of inflammation during the acute phase has been reported in the literature. It remains a promising therapeutic alternative and has its place in the control of inflammatory signs.