charcot arthropathy as result of diabetic neuropathy

This patient with diabetic peripheral neuropathy has developed foot erythema, warmth, and edema following minor trauma (eg, bumping the foot), suggesting acute neuropathic (Charcot) arthropathy.  Acute neuropathic arthropathy is characterized by an exaggerated, local inflammatory response that is usually triggered by minor trauma (often unbeknownst to the patient).

X-rays during the acute phase of neuropathic arthropathy typically reveal only soft tissue swelling without bony changes.  Early recognition of acute neuropathic arthropathy and treatment with a foot cast reduce edema and help the patient avoid weight bearing, thereby protecting the foot from further injury.  The cast is typically changed every 1-2 weeks to allow for resolving edema.

As inflammation subsides, a gradual return to protected weight bearing (eg, orthotic walker) followed by well-fitting shoes with orthotic shoe inserts can help prevent chronic neuropathic arthropathy caused by continued trauma.  Chronic neuropathic arthropathy is characterized by significant, irreversible abnormalities in bone and skin/soft tissue.

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