Authors (including presenting author) :
Wan SK, Wong CF
Affiliation :
Department of Podiatry, Yan Cha Hospital, Kowloon West Cluster
Introduction :
Charcot neuroarthropathy (CN) is an uncommon but devastating condition that causes rocker-bottom foot in diabetic patients. Early diagnosis and intervention, including immobilization, are crucial for improving clinical outcomes in preventing foot deformity. However, a 2022 systematic review found diagnostic delays averaging 12.4 weeks, underscoring the need for timely treatment. Delayed intervention not only increases healthcare costs but also affect patients’ psychosocial well-being.
Objectives :
This case report aims to demonstrate how early identification and intervention of CN can prevent progression to rocker-bottom foot deformity in a diabetic neuropathic patient.
Methodology :
This paper reports the disease progression and management of a CN case retrospectively at the podiatry clinic of Yan Cha Hospital from January 2024 to October 2024.
Presentation
Mr. Tam, aged 58, was newly diagnosed with Type II diabetes and neuropathy, and was referred to podiatry for left plantar heel ulcer management. Initially, there was no redness, heat, or swelling around the heel wound on 23/1/2024. However, 4 weeks later, his left midfoot became swollen, showing mild pes planus and a foot temperature difference (FTD) of 2.1°C, compared to his contralateral foot, while the heel wound remained stable. Redness, heat, and swelling signs not improving at the 24/3/2024 follow-up (considered baseline day 0) raised concern for acute CN. We therefore advised the patient to get x-rays immediately and minimize weight-bearing activities. By week 3, x-rays showed osteolytic lesions, and the persisting clinical presentation further raised a red flag for acute CN. We prescribed a removable Scotchcast boot for left foot offloading plantar pressure before the patient could consult an orthopaedic surgeon.
Result & Outcome :
- After 2 weeks of using the Scotchcast boot, FTD decreased to 1.1°C.
- FTD stabilized at around 1°C thereafter.
- At the week 24 follow-up, FTD was nearly negligible (< 0.3°C). The medial longitudinal arch decreased, and standing x-ray showed calcaneal pitch dropped from 17° (week 16) to 13° (week 30) but no rocker-bottom deformity developed.
Conclusion
In this case, treatment began 3 weeks after increased suspicion of acute CN, without waiting for MRI confirmation at week 22. We demonstrated early diagnosis and intervention with the Scotchcast boot helped slow disease progression and the development of rocker-bottom foot deformity.
