Indium-111-leukocyte/technetium-99m-MDP bone and magnetic resonance imaging: difficulty of diagnosing osteomyelitis in patients with neuropathic osteoarthropathy.
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Fourteen patients (16 sites) with clinical and/or radiographic evidence of neuropathic osteoarthropathy (Charcot joints) were evaluated with combined indium-111-leukocyte (111In-WBC) and technetium-99m-methylene diphosphonate (99mTc-MDP) bone imaging for suspected osteomyelitis. Magnetic resonance (MR) images were obtained in seven patients. Using a positive bone culture as the criterion for the presence of osteomyelitis, there were four true-positive studies, six true-negative sites, and one false-negative 111In-WBC study. Five of 16 sites (31%) had false-positive 111In-WBC uptake at noninfected sites. There were four true-positive and three false-positive MR studies. All false-positives showed at least moderately abnormal findings by both techniques at sites of rapidly progressing osteoarthropathy of recent onset. In this preliminary study, both techniques appear to be sensitive for detection of osteomyelitis, and a negative study makes osteomyelitis unlikely. However, the findings of 111In-WBC/99mTc-MDP and MR images at sites of rapidly progressing, noninfected neuropathic osteoarthropathy may be indistinguishable from those of osteomyelitis. (+info)
Bilateral diabetic Charcot foot.
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BACKGROUND: Charcot neuro-osteoarthropathy (CNO) of the foot is a devastating neuropathic complication of diabetes. It is characterised by deformity of the foot architecture,which can be initiated by trauma to the neuropathic limb or occur spontaneously.The acute phase of the disease is often misdiagnosed and can rapidly lead to deformity and amputation. The aim of management is to halt further bone destruction through immobilisation of the affected limb. OBJECTIVE: To discuss the diagnosis and management of bilateral diabetic CNO of the foot, diagnosed early according to clinical presentation with normal radiograph findings (Eichenholtz stage 0). DISCUSSION: The importance of early detection of clinical signs and subsequent diagnosis of CNO of the foot is vital in order to allow for the institution of management, with the aim of preserving normal foot architecture. (+info)
Successful treatment of nonunion with teriparatide after failed ankle arthrodesis for Charcot arthropathy.
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The management of Charcot midfoot deformities in diabetic patients.
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Charcot foot neuropathic osteoarthropathy is a disorder affecting the soft tissues, joints, and bones of the foot and ankle. The disease is triggered in a susceptible individual through a process of uncontrolled inflammation leading to osteolysis, progressive fractures and articular malpositioning due to joint subluxations and dislocations. The progression of the chronic deformity with a collapsed plantar arch leads to plantar ulcerations because of increased pressure on the plantar osseous prominences and decreased plantar sensation. Subsequent deep soft tissue infection and osteomyelitis may result in amputation. The Charcot foot in diabetes represents an important diagnostic and therapeutic challenge in clinical practice. Conservative treatment remains the standard of the care for most patients with neuropathic disorder. Offloading the foot and immobilization based on individual merit are essential and are the most important recommendations in the active acute stage of the Charcot foot. Surgical realignment with stabilization is recommended in severe progressive neuropathic deformities consisting of a collapsed plantar arch with a rocker-bottom foot deformity. (+info)