Charcot Neuroarthropathy Versus Osteomyelitis: A Case Series

Dr. Hau Pham provides background and additional details regarding their article, Charcot Neuroarthropathy Versus Osteomyelitis: A Case Series. Additional authors of the case series include Elizabeth Sanders, DPM; Ewald R. Mendeszoon, DPM; and Wei Tseng, DPM. Read the full article here.
 

My name is Hau Pham. I'm a podiatrist. I've been working at Boston Medical Center in Boston for about 20 years now. I have an interest in diabetic, and that's what my fellowship was in, anyway, so I've been there. We see a lot of patient with diabetes, and we see some Charcot [inaudible 00:00:37]. It's been a very interesting topic for me, and I'm just happen to see a lot of interesting case, and I start collecting those case, and take them to study the x-ray. Formally, in the old day, we not used to taking clinical picture. I wish I did. That would help my paper more, but we only had x-ray, so that's good. I keep a lot of record of all the case that I see, that I feel quite interesting.

Then, I decided I start writing paper on this case. The Charcot is one case that I like to do, and I thought it would be very helpful for the people because acute Charcot is commonly mistaken with the infection. Then, I know a lot of people end up having go to the surgery just because they had a swelling foot, and they end up having Charcot, not infection. Many of them didn't really need the surgery.

I want to write a paper to raise awareness that, if a patient come in with a red and swollen foot, with no ulcer, it's more likely to be a Charcot, not infection. I just want to raise that point. It's very interesting because you can see, in this paper, that the patient came in with a red, swollen foot. We x-ray, and we see something look like a fracture, and then we decide that this more likely to be Charcot. We continue to keep treating the patient, and [inaudible 00:02:52] not taking them to surgery, to do bone surgery. I think that's the important point I want to raise in my paper, is that we had to... the physician should know about the Charcot as well as the infection so can make the correct diagnosis, and don't bring the patient to the operating room if we don't need to.

The one thing that I always teach my resident is that if you see a red and hot, swollen foot, and there's no ulcer, that should give you a clue that this is not infection because, osteomyelitis, the patient can present with similar symptom: red, hot, swollen, with fever, and they all had diabetes. The big difference is that they don't have ulcer. People with Charcot don't have the ulcer. Charcot is very important topic, but Charcot is not that common, but we do have a lot of patient with that, so we are still doing a lot of cell initiate research about this topic, not just medical management, but surgical management for Charcot. We always want to do more research so that we can help the patient keep their foot.