糖尿病夏科氏足

Diabetic male with red, swollen left foot after jogging

A 46-year-old male police officer presented to our rheumatologic clinic with a red, swollen left foot (Fig. 1). His left foot and lower leg became progressive swollen, reddish, hot and indurated after running 3000m 2 months ago. He was found incidentally to have type 2 diabetes 18 months ago during a health exam. His diabetes was not well controlled, with HbA1c mostly above 10 %. Lower leg NCV revealed sensori-motor polyneuropathy, which implied DM neuropathy. A plain radiograph of the foot showed soft tissue swelling, fractures of the first four metatarsals, and tarsal-metatarsal joint dislocation with callus formation (Fig. 2). The clinical diagnosis of Charcot joint was made based on the clinical findings of painless swelling/redness and X-ray findings of fracture/dislocation in a patient with poorly controlled diabetes. We offloaded the foot in a plaster cast and advised the patient to limit weight bearing. A similar patient may be mistakenly thought to have gout, ankle sprain, or deep venous thrombosis, and infection instead. The Charcot foot of diabetes mellitus is not uncommon in the diabetes clinic and yet is not widely recognized by other specialists. The delay in correct diagnosis can be harmful and lead to further destruction [1].