Charcot Neuroarthropathy — SCE Rheumatology MCQ

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ModerateOsteoarthritisCharcot NeuroarthropathySCE Rheumatology

A 65-year-old man with long-standing type 2 diabetes and established peripheral sensory neuropathy develops unilateral swelling and increased warmth of the midfoot. The skin is intact, he is afebrile, and he reports little pain. Weight-bearing radiographs show midfoot joint fragmentation, subluxation and disorganisation with bony debris and new bone formation. What is the most likely diagnosis?

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Correct answer: A — Charcot neuroarthropathy

The diagnosis is **Charcot neuroarthropathy**. The decisive features are established diabetic sensory neuropathy, an intact unilateral hot swollen foot with disproportionately little pain, and radiographic fragmentation, subluxation, bony debris and joint disorganisation. Loss of protective sensation permits repetitive unrecognised trauma, while inflammatory bone turnover contributes to progressive collapse and deformity. NICE advises considering acute Charcot arthropathy even when pain or deformity is absent. Gout and septic arthritis usually cause appreciable pain; septic arthritis is also more likely with systemic illness, an entry site or inflammatory features, although infection must be excluded clinically. Osteoarthritis does not usually produce an acutely hot swollen foot or such severe fragmentation and disorganisation. Paget disease causes bone expansion and altered trabeculation rather than this neuropathic joint pattern. Suspected acute Charcot disease requires urgent multidisciplinary foot-service referral and immediate offloading.

Reference: National Institute for Health and Care Excellence. Diabetic foot problems: prevention and management (NG19), section 1.7 Charcot arthropathy. 2015, updated 2019. https://www.nice.org.uk/guidance/ng19/chapter/Recommendations