Varied presentations and outcomes of Charcot neuroarthropathy in patients with diabetes mellitus

Charcot neuroarthropathy (CN) of the foot is uncommon and CN of atypical sites like wrist is sparingly described. CN is grossly under-diagnosed or misdiagnosed by primary care physicians. CN may present in acute phase with classical signs of inflammation or with deformities in chronic phase. The present study describes varied presentations, diagnostic dilemmas, and outcomes of CN in patients with diabetes. Data from the electronic repository of patients with diabetes and foot complications was obtained. The repository has a pre-designed structured format for information pertaining to the patients’ anthropometry, presentation, neurological, vascular and foot examination details, treatment offered, and outcomes on follow-up. In addition, literature search for prior reported cases of atypical site (wrist) of CN was conducted. Data of 206 subjects with foot CN and two cases of atypical joint amongst 1297 patients with diabetes mellitus was screened. The particulars of patients with varied presentation viz. acute phase (case 1), stable foot deformities in chronic phase (case 2), and unstable foot with destruction of ankle joint in hindfoot CN (case 3) are presented along with the differential diagnosis and their outcomes on follow-up at 36 months of presentation. A literature search for atypical site of CN revealed only nine cases of wrist CN. The diagnosis of wrist CN was not initially considered and misdiagnosed. Patient with CN may present in active phase or more commonly with deformities and destroyed joints. The acute CN is misdiagnosed as cellulitis and inadvertently treated with antibiotics. Wrist and MCP joint CN is extremely rare and the diagnosis of CN requires a high index of suspicion supported by radiography findings.