skip to main content

Acute Charcot arthropathy — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

HardAnkle and FootAcute Charcot arthropathyMSRA

A 61-year-old man with type 2 diabetes attends with a 36-hour history of painless swelling, warmth and erythema of his left midfoot after stepping off a kerb. He has diabetic peripheral sensory neuropathy and CKD G4 (eGFR 24 mL/min/1.73 m²). He has no previous ulceration. The skin is intact, pedal pulses are palpable and capillary refill is normal. He is afebrile and systemically well; CRP and white cell count are normal. There is no calf swelling. Weight-bearing foot and ankle radiographs show no fracture or dislocation. Compared with the right foot, the affected foot is 3.1°C warmer. What is the most appropriate management today?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Advise strict non-weight-bearing, refer within 1 working day to the multidisciplinary foot care service, and arrange MRI because suspicion remains despite normal radiographs

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · B = shown as D · A = shown as E

This presentation is most consistent with acute Charcot arthropathy: an unexplained hot, swollen, erythematous foot with intact skin in a person with marked peripheral neuropathy and renal impairment. Minimal pain and initially normal radiographs do not reduce the concern; NICE specifically advises considering Charcot even without pain or deformity. The absence of ulceration, systemic illness, ischaemia and biochemical inflammatory response makes cellulitis, deep diabetic foot infection and a limb-threatening diabetic foot emergency less likely. A normal weight-bearing radiograph does not exclude early Charcot arthropathy, so MRI should be considered when clinical suspicion persists. Until specialist assessment and definitive offloading, he should not weight-bear, and referral to the multidisciplinary foot care service is required within 1 working day. A is plausible because the foot is red and warm, but there is no skin breach or convincing infectious syndrome. C risks ongoing microtrauma and progression to collapse. D would be appropriate with sepsis, gangrene, limb ischaemia or concern about deep infection, none of which is present. E provides inadequate urgency and a removable device is not the recommended initial primary-care response before specialist assessment.

Reference: NICE NG19: Diabetic foot problems: prevention and management — Charcot arthropathy recommendations (Updated 11 October 2019) — https://www.nice.org.uk/guidance/ng19/chapter/Recommendations