Radiographic abnormalities in the feet of patients with diabetic neuropathy.
OBJECTIVE
To investigate the prevalence of radiographic bone and joint abnormalities in the feet of diabetic patients.


METHODS
In a blinded randomized study, 94 diabetic patients with peripheral neuropathy (54 with a history of foot ulcers) and 43 non-neuropathic patients were drawn at random from the data base of a large university diabetes clinic in the United Kingdom. Fifty nondiabetic age-matched control subjects also were studied. Lateral and dorsi-plantar weight-bearing plain radiographs of the foot and ankle were taken by a single radiographer. Abnormalities in the bones and joints were determined according to a structured reading of the radiographs by a single radiologist.


RESULTS
Diabetes per se resulted in no excess of bony abnormality. Diabetic patients with neuropathy had significantly more radiographic abnormalities of the bones and joints than non-neuropathic and age-matched nondiabetic control subjects. However, except for periosteal reaction, this was predominantly caused by an excess of abnormalities in diabetic patients with a history of foot ulceration. Traumatic fractures (most previously unrecognized) were found in 12 (22%) of the 54 neuropathic patients with previous foot ulceration, and 9 (16%) patients who had experienced foot ulcers exhibited characteristic Charcot changes.


CONCLUSIONS
These results suggest that bony abnormalities, particularly Charcot changes and traumatic fractures, are more frequent than previously recognized in neuropathic diabetic patients, especially in those with a history of foot ulceration. Early recognition of bony abnormality and appropriate treatment may prevent progression of foot deformity and thereby reduce the morbidity caused by ulceration or reulceration.
Cavanagh
P R
PR
Center for Locomotion Studies, Penn State University, University Park 16802.
Young
M J
MJ
Adams
J E
JE
Vickers
K L
KL
Boulton
A J
AJ
D000328:Adult; D001175:Arthrography; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017719:Diabetic Foot / Q000000981:diagnostic imaging*; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method