Endocrine Abstracts

Introduction: Charcot foot is a rare and particular form of diabetic foot that presents a diagnostic and therapeutic challenge. It can lead to gross structural deformities of the foot and ankle, and subsequent skin ulceration and lower limb amputation from soft tissue or bony infection.

Case report: We report the case of Mr B.D, aged 55, type 2 diabetic for 29 years, poorly controlled despite intensified insulin treatment, at the stage of micro and macroangiopathic complications. He is hypertensive on triple therapy and has a history of multiple episodes of infection in both feet, resulting in amputation of the distal phalanx of the left big toe. He was admitted to our department for treatment of a left plantar neuropathic ulcer. Clinical examination revealed a plantar ulceration on the left foot opposite the 1st metatarsal head measuring 3 cm, painless, surrounded by significant hyperkeratosis and not infected, claw-like deformity of the 2nd toe. Both feet flat, oedematous, dry skin and hyperkeratosis of the heels, monofilament tactile sensitivity and achilles reflex abolished, neuropathic pain graded 5/10 according to DN4, permanent pain in both ankles. Normal IPS at 1.18 on the right and 1.12 on the left. This the lesion can be classified P1E2D2I1S2 according to the PEDIS classification on feet classified guard 3 according to podological risk. Investigation revealed fasting blood glucose of 1.24, HbA1c of 11% and a negative inflammatory panel. The standard X-ray of the left foot was without abnormality, while the MRI revealed extensive remodelling of the Chopart’s joint space, suggestive of Charcot foot. Standard radiography of the right foot revealed major osteoarticular destruction of the ankle, suggestive of Charcot foot, confirmed by CT and MRI. Treatment consisted of progressive control of diabetes, strict off-loading of both feet by Aircast with preventive anticoagulation. Local care and oily dressings twice a week.

Discussion: Diabetic osteoarthropathy is a serious complication of diabetes whose early diagnosis is complex and often delayed. It manifests itself in the acute phase by localized inflammation of the foot or ankle, and in the absence of discharge. It leads to severe bone damage. Cases of bilateral Charcot’s Foot are not frequent, from 5.9-39.3% of cases according to studies. Accurate diagnosis can lead to appropriate treatment and subsequent reduction in the risk of skin ulceration and lower limb amputation among an already high risk population.