Introduction: Charcot neuroarthropathy (CN) is a complication of diabetic peripheral neuropathy. We present a case of diabetic foot infection (DFI) associated with CN.
Case: A 44-year-old male with type 2 diabetes, peripheral vascular disease, neuropathy and previous DFI, was admitted with right foot pain and redness. Barriers to effective diabetes care included depression and low health literacy, compounded by reduced in-person outpatient reviews amid the COVID-19 pandemic. Right foot assessment revealed cellulitis and a rocker-bottom deformity, with radiographic evidence of CN predominantly involving the navicular bone. He discharged against medical advice, leading to suboptimal foot care with CN management including offloading not being implemented. After six months, during which time he did not attend any podiatry clinic or the diabetic foot service and continued normal weight-bearing, he presented with increasing right foot pain and swelling, with a right ankle ulcer unresponsive to 5 months of oral antibiotics prescribed by his general practitioner. Rapid radiographic progression of CN, evidenced by complete destruction of the right tarsal bones, midfoot articulations and tarsometatarsal joints, was associated with MRI features of septic arthritis and tenosynovitis. The extent of his DFI was masked by the prolonged use of oral antibiotic therapy prior to admission, leading to delayed presentation and inadequately treated infection. His contralateral foot had no stigmata of DFI. He required a right below-knee amputation as his foot was deemed non-viable and underwent inpatient rehabilitation after surgery.
Conclusion: Our case highlights the devastating sequalae of suboptimally-treated CN. Despite multiple healthcare contacts and opportunities for interventions, appropriate management of CN was not initiated, suggesting a lack of awareness of its treatment and disease course among some healthcare professionals, although patient factors were also implicated. Increased vigilance and timely intervention of CN are vital to impede debilitating structural deformities and the risks of ulceration and amputation.