Spot the Diagnosis

Saranya C MD (General Medicine), DM (Rheumatology)
Professor, Department of Rheumatology, Saveetha Medical College and Hospital, Chennai

Case details

A 46-year-old female, known diabetic for 14 years, presented to Rheumatology OPD with complaints of pain and swelling of left ankle and feet for 2 weeks. No history of trauma, fever, constitutional symptoms, or recent infection in the past. On examination, her left foot was diffusely swollen, and erythematous with tenderness in the subtalar, midtarsal, and tarsometatarsal joints.

1. What is the likely diagnosis?

2. What are the radiological findings?

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Answer Key:

Diabetic Charcot’s osteoarthropathy
Plain radiographs of left feet showed disorganized tarsal bones with superior displacement of the navicular bone (blue arrows) (Figure B, C). CT scan showed severe erosion of all cuneiform bones, erosion of the base of 2-5th metatarsals with superior displacement of navicular bone, mild erosion in talus, and soft tissue inflammatory changes (red arrows) (Figure D, E).