Salvage of Chronic Therapy-Resistant Bilateral Charcot Foot Osteoarthropathy with Signs of Osteomyelitis

Abstract

Charcot arthropathy is an insidious condition affecting the lower limbs of diabetic patients. It is a complication of diabetic neuropathy resulting from subsequent Wallerian degeneration of the nerves. This complication may eventually lead to limb amputation and a poor patient prognosis if not diagnosed and treated successfully. Herein, we report the case of a 73-year-old female who presented with rapidly progressive bilateral Charcot foot over a 5-week period, necessitating an exostectomy on the mid foot, specifically on the cuboid bone and the navicular cuneiform joint. Her presentation with rapidly progressing foot ulcers on the plantar aspect prompted initial treatment based on osteomyelitis. The report will therefore serve as a useful guide on how to properly treat Charcot foot, which may present in an atypical manner.

Keywords: Diabetic ulcers; Endocrinology; Infectious disease; Orthopaedic surgery.

Fig. 1

Initial presenting ulcer on the right foot

Fig. 2

Initial presenting ulcer on the left foot

Fig. 3

Left foot X‐ray pre‐operation, showing Charcot destruction of the metatarsal cuneiform cuboid joint and navicular cuneiform joint with rocker bottom foot and collapse of mid‐foot with a prominence of cuboid and cuneiform bones dislocated plantarly

Fig. 4

Postoperative presentation of the left foot, showing the recovering ulcer and improvement of the wound

Fig. 5

Left foot X‐ray post‐operation

Fig. 6

Right foot X‐ray presentation post‐operation

Fig. 7

Right foot X‐ray pre‐operation