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Original article

Vol. 143 No. 3132 (2013)

The acute diabetic Charcot foot managed on the basis of magnetic resonance imaging – a review of 71 cases

  • Ernst Adolf Chantelau
  • Andreas Richter
Cite this as:
Swiss Med Wkly. 2013;143:w13831


  1. Aragon-Sanchez J, Lazaro-Martinez JL, Hernandez-Herrero MJ. Triggering mechanisms of neuroarthropathy following conservative surgery for osteomyelitis. Diabet Med. 2010;27:844–7.
  2. Johnson JTH. Neuropathic fractures and joint injuries. Pathogenesis and rationale for prevention and treatment. J Bone Joint Surg. (Am) 1967;49-A:1–30.
  3. Mountziaris PM, Mikos AG. Modulation of the inflammatory response for enhanced bone tissue regeneration. Tissue Engineering B. 2008;14:179–86.
  4. Cobos EJ, Ghasemlou N, Araldi D, Segal D, Duong K, Woolf CJ. Inflammation-induced decrease in voluntary wheel running in mice: a nonreflexive test for evaluating inflammatory pain and analgesia. Pain. 2012;153:876–84.
  5. Onvlee GJ. The Charcot foot: a critical review and an observational study of a group of 60 patients [Thesis]. Medical Faculty. University of Leiden/The Netherlands, 1998.
  6. Minde JK, Svensson O, Holmberg M, Solders G, Toolanen G. Orthopaedic aspects of familial insensitivity to pain due to a novel nerve growth factor beta mutation. Acta Orthop. 2006;77:198–202.
  7. Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, et al. The Charcot foot in diabetes. Diabetes Care. 2011;34:2123–9.
  8. Greider TD. Orthopaedic aspects of congenital insensitivity to pain. Clin Orthop Relat Res. 1983;172:177–85.
  9. Yalcin S, Kocaoglu B, Berker N, Erol B. Conservative treatment of Charcot arthropathy in a series of spina bifida patients: the experience of one centre and review of the literature. J Pediatr Orthop B. 2007;16:373–9.
  10. Rangel EB, Sa JR, Gomes SA, Carvalho AB, Melaragno CS, Gonzalez AM, et al. Charcot neuroarthropathy after simultaneous pancreas-kidney transplant. Transplantation. 2012;94:642–5.
  11. Eichenholtz SN. Charcot Joints. With a foreword by Philip D. Wilson. Springfield, Illinois: Charles C. Thomas, Publisher. 1966.
  12. Classen JN, Rolley RT, Carneiro R, Martire JR. Management of foot conditions of the diabetic patient. Am Surg. 1976;42:81–8.
  13. Edmonds ME, Watkins PJ. The Charcot joint: understanding its natural history leads to new treatment and prevention. Abstract. Diabet Med. 1984;1:144A.
  14. Shibata T, Tada K, Hashizume C. The results of arthrodesis of the ankle for leprotic neuroarthropathy. J Bone Joint Surg. (Am) 1990;72-A:749–56.
  15. Moore TE, Yuh WTC, Kathol MH, El-Khoury GY, Corson JD. Abnormalities of the foot in patients with diabetes mellitus: findings on MR imaging. AJR. 1991;157:813–6.
  16. Greenstein AS, Marzo-Ortega H, Emery P, O’Connor P, McGonagle D. Magnetic resonance imaging as a predictor of progressive joint destruction in neuropathic joint disease. Arthritis Rheum. 2002;46:2814–6.
  17. Edmonds E, Petrova NL, Elias D. The earliest magnetic resonance imaging sign of mid-foot Charcot osteoarthropathy is oedema of subchondral (subarticular) bone marrow which needs prompt therapeutic offloading. Abstract. Diabet Med. 2005;22(Suppl.2):93.
  18. Edmonds ME, Petrova NL, Edmonds A, Elias A. Early identification of bone marrow oedema in the Charcot foot on MRI allows rapid intervention to prevent deformity. (Abstract) Diabet Med. 2006;23(Suppl.2):70.
  19. Edmonds ME, Petrova NL, Edmonds AE, Elias DA. What happens to the initial bone marrow oedema in the natural history of Charcot osteoarthropathy? Abstract. Diabetologia. 2006;49(Suppl.1): A–684.
  20. Chantelau E, Richter A, Schmidt-Grigoriadis P, Scherbaum WA. The diabetic Charcot foot: MRI discloses bone stress injury as trigger mechanism of neuroarthropathy. Exp Clin Endocrinol Diabetes. 2006;114:118–23.
  21. Halstead J, Bergin D, Keenan AM, Madden J, McGonagle D. Ligament and bone pathologic abnormalities more frequent in neuropathic joint disease in comparison with degenerative arthritis of the foot and ankle. Arthritis Rheum. 2010;62:2353–8.
  22. Sella EJ, Barrette C. Staging Charcot neuroarthropathy along the medial column of the foot in the diabetic patient. J Foot Ankle Surg. 1999;38:34–40.
  23. Chantelau E, Richter A, Ghassem-Zadeh N, Poll L. “Silent” stress injuries in the feet of diabetic patients with polyneuropathy-a report on 12 cases. Arch Orthop Trauma Surg. 2007;127:171–7.
  24. Kimmerle R, Chantelau E. Weight-bearing intensity produces Charcot deformity in injured neuropathic feet in diabetes. Exp Clin Endocrinol Diabetes. 2007;115:360–4.
  25. Sinacore DR. Acute Charcot arthropathy in patients with diabetes mellitus: healing times by foot location. J Diabetes Complications. 1998;12:287–83.
  26. Saltzman CL, Hagy ML, Zimmerman M, Estin M, Cooper R. How effective is non-operative initial treatment of patient with diabetes and Charcot arthropathy of the feet? Clin Orthop Relat Res. 2005;435:185–90.
  27. Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR. The natural history of acute Charcot’s arthropathy in a diabetic foot specialty clinic. Diabet Med. 1997;14:35763.
  28. Fabrin J, Larsen K, Holstein PE.Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care. 2000;23:796–800.
  29. Christensen TM, Gade-Rasmussen B, Pedersen LW, Hommel E, Holstein PE, Svendsen OL. Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker. J Diabetes Compl. 2012;26:430–4.
  30. Chantelau E. The perils of procrastination: effects of early vs. delayed detection and treatment of incipient Charcot fracture. Diabet Med. 2005;22:1707–12.
  31. Ghassem-Zadeh N. MRI-guided early treatment of stress bone injuries at the foot in diabetic polyneuropathy (MRT-gesteuerte Frühtherapie knöcherner Stressverletzungen am Fuss bei diabetischer Polyneuropathie). Thesis [in German]. Medical Faculty of the Heinrich- Heine-University Düsseldorf/Germany 2008.
  32. Chantelau E, Poll LW. Evaluation of the diabetic Charcot foot by MR imaging or plain radiography- an observational study. Exp Clin Endocrinol Diabetes. 2006;114:428–31.
  33. Kiuru MJ, Pihlajamaki HK, Ahovuo JA. Bone stress injuries. Acta Radiol. 2004;45:317–26.
  34. Wienemann T, Chantelau EA. The diagnostic value of measuring pressure pain perception in patients with diabetes mellitus. Swiss Med Wkly. 2012;142:w13682.
  35. Zampa V, Bargellini I, Rizzo L, Turini F, Ortori S, et al. Role of dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus. Skeletal Radiol. 2011;40:991–9.
  36. McGill M, Molyneaux L, Bolton T, Ioannou K, Uren R, Yue DK. Response of Charcot’s arthropathy to contact casting: assessment by quantitative techniques. Diabetologia. 2000;43:482–4.
  37. Cook JJ, Cook EA. Protected weight bearing during treatment of acute Charcot neuroarthropathy: a case series. The Foot and Ankle Online Journal. 2011;4(7):1.
  38. Sims DS, Cavanagh PR, Ulbrecht JS. Risk factors in the diabetic foot. Recognition and management. Phys Ther. 1988;68:1887–903.
  39. Wu SC, Crews RT, Najafi B, Slone-Rivera N, Minder JL, Andersen CA. Safety and efficacy of mild compression (18–25 mm Hg) therapy in patients with diabetes and lower extremity oedema. J Diabetes Sci Technol. 2012;6:641–7.
  40. Zwipp H, Baumgart F, Cronier P, Jorda E, Klaue K, et al. Integral classification of injuries (ICI) to the bones, joints and ligaments- application to injuries of the foot. Injury, Int J Care Injured. 2004;35:S-B3- S-B9.
  41. Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. Am J Roentgenol. 2004;183:615–22.
  42. Peicha G, Preidler KW, Lajtai G, Seibert FJ, Grechenig W. Diagnostische Wertigkeit von Nativröntgen, Computer- und Magnetresonanztomographie beim akuten Hyperflexionstrauma des Fusses. [Article in German] Unfallchirurg. 2001;104:1134–9.
  43. Ruotolo V, Giurato L, Meloni M, Masala S, Schillaci O, Bergamini A, et al. A new natural history of Charcot foot: clinical evolution and final outcome of stage 0 Charcot’s arthropathy in a tertiary care foot clinic. F-18 FDG PET/CT scan: a useful tool in diagnosis and follow-up of acute Charcot foot. Abstract O4. Diabetic Foot Study Group. Meeting 2012, Potsdam/Germany.
  44. Brand PW. Insensitive feet. A practical handbook on foot problems in leprosy.1966, revised 1977. The Leprosy Mission, London. p 52–53.
  45. Bailey CC, Root HF. Neuropathic foot lesions in diabetes mellitus. N Engl J Med. 1947;236:397–401.
  46. Chantelau E, Wienemann T, Richter A. Pressure pain thresholds in the diabetic Charcot-foot: an exploratory study. J Musculoskelet Neuronal Interact. 2012;12:95–101.
  47. American College of Radiology. ACR Appropriateness Criteria®: Suspected Osteomyelitis of the Foot in Patients with Diabetes mellitus. Last review date 2012., accessed 9.1.2013.
  48. Weishaupt D, Schweitzer ME, Alam F, Karasick D, Wapner K. Imaging of inflammatory joint diseases of the foot and ankle. Skeletal Radiol. 1999;28:663–9.
  49. Weishaupt D, Schweitzer ME. MR imaging of the foot and ankle: patterns of bone marrow signal abnormalities. Eur Radiol. 2002;12:416–26.
  50. Rios AM, Rosenberg ZS, Bencardino JT, Rodrigo SP, Theran SG. Bone marrow oedema patterns in the ankle and hindfoot: distinguishing MRI features. AJR. 2011;197:W720–W729.
  51. Teh J, Suppiah R, Sharp R, Newton J. Imaging in the assessment and management of overuse injuries in the foot and ankle. Semin Musculoskelet Radiol. 2011;15:101–14.
  52. Eyres KS, Kanis JA. Bone loss after tibial fracture. J Bone Joint Surg. [Br] 1995;77-B:473–8.