Charcot Neuroarthropathy: A Narrative Review of the Diagnosis Routinely Missed at First Presentation
DOI:
https://doi.org/10.5281/zenodo.22261613Keywords:
Charcot neuroarthropathy, Diabetic foot, Diagnostic delay, Misdiagnosis, OffloadingAbstract
Charcot neuroarthropathy presents acutely as a hot, swollen foot in which pain may be absent or disproportionate, and it is
mistaken for cellulitis, deep vein thrombosis, osteomyelitis or injury. In a referral cohort of 22 patients, the referring provider
correctly identified the diagnosis in one. The consequence is measurable. Fifteen of those 22 progressed to bone destruction and
had a mean of 8.7 weeks between symptom onset and diagnosis, while the seven who were seen an average of 4.6 weeks earlier did
not progress; ten of the fifteen subsequently required surgery, at a mean of 2.9 operations per limb. Systematic review found
misdiagnosis or delay in a majority of reported cases, with mean time to correct diagnosis approaching three months. The
mechanism of the delay is specific: at the earliest stage the plain radiograph is normal, so imaging that appears to exclude the
diagnosis does not. The bedside sign is a temperature difference of more than 2 degrees Celsius against the other foot.
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