OSTEOMYELITIS IN DIABETIC FOOT

 

Osteomyelitis in diabetic foot is infection of the bone that 90% are results from contiguous spread of a skin ulcer. Consequently, the most common location for osteomyelitis is at the pressure points of the forefoot (metatarsal heads, IP joints) and in the hindfoot at the plantar aspect of the posterior calcaneus. Classic triad of osteomyelitis in plain radiograpy are lucencies, periosteal reaction, and bony destruction.

Unlike osteomyelitis, Charcot neuroarthropathy is primarily an articular disease and not related to overlying skin or soft tissue changes. Charcot neuroarthropathy commonly involves multiple midfoot bones. Features include joint instability, dislocation, destruction, disorganization, increased bone density, joint debris and deformity. Presence of subchondral cysts and intraarticular bodies with absence of the secondary signs for osteomyelitis support neuroarthropathy without infection.

In the early stage radiography will not demonstrate bone abnormalities, but MRI will show subchondral bone marrow edema. The subcutaneous soft tissues are not typically involved in Charcot arthropathy.

Osteomyelitis in chronic Charcot is usually located in the midfoot, while osteomyelitis in diabetic neuropathy without Charcot is usually in the forefoot and hindfoot.

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