Charcot Neuroarthropathy — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesCharcot NeuroarthropathyRACP Adult Medicine

A 45-year-old man with type 2 diabetes presents with a painless, swollen, warm right ankle. X-ray shows destruction of the talonavicular joint with fragmentation and new bone formation. His peripheral pulses are intact and sensation is reduced. HbA1c is 80 mmol/mol. What is the most likely diagnosis?

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Correct answer: B — Charcot neuroarthropathy

Charcot neuroarthropathy (Charcot foot) occurs in diabetic patients with peripheral neuropathy. It presents as a warm, swollen, deformed foot/ankle that may be painless or minimally painful. X-ray findings include joint destruction, fragmentation, subluxation, and new bone formation (the '5 Ds': distension, dislocation, debris, disorganisation, density increase). Initial management is strict non-weight-bearing and total contact casting. It is commonly misdiagnosed as infection.

Reference: eTG – 2025 – Endocrinology; IWGDF – 2023 – Charcot Foot Guidelines