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I have a new male patient 72 y.o. with some sort of neuropathy (loss of protective sensation and loss of vibratory sensation), non-diabetic, presented to clinic with neuropathic apical ulcers on the right foot with severe edema and severe hemosiderosis, some possible cellulitis on 2nd toe ...if I want to also assess him for charcot arthropathy - should I get an x-ray or right to MRI? Is X-ray worth anything in this case?

2nd visit - patient's ulcers were clearing up nicely from topical and oral ABx given first visit, dealing with aspect of footwear and pressure now, erythema on second toe clearing up and even temp difference between each foot is now less...and no signs of foot deformity...am I just overly concerned or should I check for charcot ?

C.F.G.

 

Hi Gary


It is always best to err on the side of caution.
Literature indicates a large incidence of a missed diagnosis with regard to Charcots arthropathy. Furthermore, what compounds this is the lack of concensus about clinical and radiological diagnostic criteria in Charcot's arthropathy.

Since there appears to be a resolution of clinical features it may not be necessary to subject the patient to any radiological investigations now. Although continued close monitoring by the patient is essential and the patient should present immediately if there is any swelling, temperature or colour changes noted.

 

Thank you for advice, most appreciated...gb

 

Patient healing nicely ...decided not to do X-ray for Charcot...thanks..

CFG