Endocrine Abstracts

Introduction: Diabetic osteoarthropathy (D.O) commonly referred to as Charcot’s foot is a complication secondary to neuropathic and inflammatory osteolysis, occurring in a setting of old and/or poorly controlled diabetes. Its pathophysiology remains poorly understood and its diagnosis must be systematically evoked in the presence of any inflammatory sign that localised to the foot or ankle occurring on a background of diabetic neuropathy.

Clinical case: Sixty four year-old female patient, diabetic since the age of 48 years on 2 premixed and rapid analogue. Her diabetes was unbalanced and she was already at the stage of degenerative complications, with the notion of amputation of the 3rd toe of the right foot following gangrene. The patient was admitted with pain in the left foot that had been evolving for 5 months, occurring in the context of prolonged walking and without any notion of trauma. Clinically, the foot was deformed, painful, with enlargement of its anteroposterior and lateromedial diameter. Biological tests revealed a high CRP and LDH without hyperleukocytosis. An X-ray of the left foot showed secondary ossifications with marginal sclerosis and exostoses. A CT scan showed hypertrophy and destruction of the bone with infiltration of the periarticular soft tissues in favour of a Charcot foot. The left foot was immobilised in a plaster cast and offloaded with the patient being put on a progressive dose of pregabalin with improvement of her pain.

Discussion: Currently diabetes is the leading cause of diabetic osteoarthropathy. Unilaterality of the disease is dominant. Intense bone demineralisation is evidence of significant autonomic damage. Our patient had a delay in diagnosis which could be explained in part by the rarity of this pathological entity and the lack of specificity of its clinical picture. The cornerstone of management is an early clinical and radiological diagnosis strict unloading of the foot, appropriate analgesia with a careful discussion of the surgical indication in the state phase in order to prevent the development of ulcerations, a major cause of amputation.

Conclusion: D.O is often under-diagnosed due to the non specificity of the clinicobiological picture. It is characterised by irreversible osteoarticular complications, hence the importance of early diagnosis with adequate management based on offloading and early immobilisation in parallel with good therapeutic education.

Key words: diabetes-osteorthropathy-unloading-surgery.