Neuropathic osteoarthropathy in the diabetic foot.
OBJECTIVE
To discuss a case involving a 55-year-old diabetic woman with neuropathic osteoarthropathy initiated by a fall.


METHODS
The patient fell into a hole, injuring her left foot. Because of the anesthesia associated with her diabetic peripheral neuropathy, she did not notice the ensuing plantar puncture wound. The patient assumed that her swelling was a result of a sprain. Mild dislocation and osseous fragmentation was noted within the midfoot on radiographs. The neuropathic osteoarthropathy progressed until the patient was later casted. Plain films taken at the time of cast removal demonstrated resorption and consolidation of fragmentation, but the dislocation was unaltered.


RESULTS
The patient was scheduled for surgery and wound debridement. However, before surgery, complications of a burn sustained on the contralateral foot required fifth ray amputation. Surgery of the left foot has been postponed until adequate postsurgical healing has occurred at the right foot amputation site.


CONCLUSIONS
This article provides tools for the timely diagnosis and treatment of neuropathic osteoarthropathy. An increased understanding of this entity will help lead to a reduction in the incidence of delayed treatment resulting from misdiagnosis.
Department of Radiology, Logan College of Chiropractic, Chesterfield, MO 63006-1065, USA.
Melanie D
MD
Osterhouse
Norman W
NW
Kettner
D000058:Accidental Falls; D000671:Amputation, Surgical; D001177:Arthropathy, Neurogenic / Q000209:etiology*; D002370:Casts, Surgical; D003646:Debridement; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D013997:Time Factors