Review Question - QID 218589

Charcot arthropathy presents with swelling and erythema of the affected extremity that resolves with elevation.

Charcot arthropathy most commonly occurs as a result of long-standing poorly controlled diabetes leading to an autonomic dysregulation of arterial blood flow and lack of protective sensation. Natural history is characterized by the progressive destruction of multiple joints and bones leading to significant deformity. This can impair patient function by limiting effective ambulation. Diagnosis can be differentiated between other pathologies by elevating the affected extremity and observing for resolution of erythema.

Dodd and Daniels reviewed Charcot neuroarthropathy of the foot and ankle. They stated the goal of treatment is to obtain a stable, plantigrade foot with either surgical or nonsurgical methods. They recommended surgical treatment in cases of recurrent ulcers, deformity, deep infection, and refractory pain.

Strotman et al. reviewed Charcot arthropathy of the foot and ankle. They stated total contact casting is recommended in the early stages of the disease with the decision to bear with determined by patient-specific factors. They further recommended nonsurgical management in late-stage disease with the use of accommodative orthoses such as a CROW.

Incorrect answers
Answer 1: An occult fracture can present with swelling and erythema, but is typically seen in patients with spinal cord injuries.
Answer 2: Cellulitis will present with erythema that does not improve with elevation.
Answer 4: A DVT will present with swelling and posterior calf tenderness. Erythema is not as common, but if associated will not improve with elevation.
Answer 5: Osteomyelitis will not present with erythema that resolves with leg elevation.