Radiographic Presentation of Delayed Diagnosis of Charcot Foot in a 56-Year-Old Patient With No Reported History of Diabetes: A Case Report.

OBJECTIVE: The purpose of this case report is to describe the radiographic presentation of a patient with neuropathic osteoarthropathy. CLINICAL FEATURES: A 56-year-old white man presented to the diagnostic imaging department of a chiropractic teaching institution for the radiographic examination of the left foot. He had a 6-month history of left foot pain unresponsive to chiropractic care. The patient had reported no history of diabetes and denied any trauma, surgery, or malignancy. INTERVENTION AND OUTCOME: Based upon the history, a 3-view radiographic examination of the left foot using computed radiography was performed. Radiographic abnormalities included osseous resorption, architectural foot disorganization, and dissociation and collapse of the anatomical alignment between the intertarsal and tarsal-metatarsal articulations. Intra-articular osseous debris formation with periarticular edema of the midfoot was noted. After the radiological diagnosis, the patient was subsequently investigated and diagnosed with type 2 diabetes mellitus. Thus, there were radiographic findings of poorly controlled or untreated diabetes mellitus with the resultant complication of neuropathic osteoarthropathy.
CONCLUSION: Some patients with type 2 diabetes may present with covert manifestations and other symptoms, such as a history of unexplained foot pain. The patient in this case with diabetes-induced neuropathic osteoarthropathy demonstrates that these findings should raise suspicion and result in an appropriate follow-up investigation.