Abstract and Introduction
Abstract
Introduction: Patients with diabetes and peripheral neuropathy have a 25% risk of developing a foot ulcer, and these can lead to soft tissue infections that worsen and result in osteomyelitis. While Charcot neuroarthropathy is not as common as osteomyelitis, it is often misdiagnosed as osteomyelitis.
Case Reports: Three patients presented with diabetes, neuropathy, and foot ulcers. They underwent prophylactic surgery but later developed swelling at the surgical sites. Radiographs showed fragmentations that caused concern about osteomyelitis. The authors maintained diagnoses of Charcot neuroarthropathy and treated the patients with immobilization and offloading. All patients resolved the fragmentations without antibiotics or surgery.
Conclusion: While Charcot neuroarthropathy and osteomyelitis have similar signs and symptoms, understanding the similarities and differences between the conditions can aid providers in appropriate wound management.
Introduction
According to the 2016 World Health Organization data, an estimated 422 million adults live with diabetes globally.[1] Diabetes prevalence is also increasing rapidly among the US population. The Centers for Disease Control and Prevention's 2019 estimates were that 28.7 million people of all ages, or 8.7% of the US population, are diagnosed with diabetes.[2]
Soft tissue ulceration in the feet is a widespread complication for patients with diabetes. The lifetime risk of DFU is 19% to 34%.[3] These ulcerations can become infected if not treated quickly or adequately. One study found that soft tissue infections advanced to OM in 20% of cases.[4] Patients present with swelling, redness, pain, and warmth in such instances, and the ulcer may have purulent discharge.
A lesser complication is CN, seen in 0.12% to 0.3% of patients with diabetes.[5] That risk increases to 16% if patients have peripheral neuropathy.[6] Patients with CN present signs similar to those of OM: swelling, redness, and warmth. However, they do not present with ulcers or a history of injury. Acute CN often gets misdiagnosed as OM.[7]
The authors report 3 cases of post-surgical patients who developed CN after healing from their surgery for chronic, non-infected ulcers. These patients presented with red, warm, and swelling feet with no new ulcers or history of trauma. The radiographic exams were read as concerning for OM. The authors maintained the findings as changes due to CN rather than OM.
Wounds. 2023;35(6):E203-E208. © 2023 HMP Communications, LLC
