Article 5221

Title of the article

Diabetic neuroosteoarthropathy (Charcot foot) and osteomyelitis (a literature review) 


Kseniya A. Bazina, Student, Medical Institute, Ogarev Mordovia State University (68 Bolshevistskaya street, Saransk, Russia), E-mail:
Ivan A. Kolosunin, Student, Medical Institute, Ogarev Mordovia State University (68 Bolshevistskaya street, Saransk, Russia), E-mail:
Sergey A. Kozlov, Doctor of medical sciences, professor, professor of the sub-department of general surgery named after professor N.I. Atyasov, Medical Institute, Ogarev Mordovia State University (68 Bolshevistskaya street, Saransk, Russia), E-mail:
Tat'yana V. Fomicheva, Student, Medical Institute, Ogarev Mordovia State University (68 Bolshevistskaya street, Saransk, Russia), E-mail:
Tat'yana V. Tsyganova, Student, Medical Institute, Ogarev Mordovia State University (68 Bolshevistskaya street, Saransk, Russia), E-mail: 

Index UDK





One of the most serious complications of diabetes mellitus is a diabetic foot with damage to soft tissues, ligamentous apparatus and bone structure. Charcot foot (there are several terms for this pathology: neuroosteoarthropathy, Charcot osteoarthropathy, Charcot joint, diabetic osteoarthropathy in the literature) is a chronic progressive disease of the bones and joints of the foot. In clinical practice, it is difficult to differentiate between Charcot foot and osteomyelitis. Charcot foot often affects the middle and back of the foot, several bones at once, followed by dislocation of the joints. As a rule, one bone of the forefoot is affected without dislocation of the joints in osteomyelitis. For osteomyelitis characterized by a triad of signs: ulcers soft tissue area of more than 2cm2; depth of the ulcer more than 3 mm; ESR 70 mm/h. In addition, osteomyelitis is characterized by a positive Bprobe-tobone test (bone sensation when probing an ulcer with a metal probe). To differentiate these two diseases, imaging methods are used: simple (conventional radiography, computed tomography, magnetic resonance imaging) and hybrid (positron emission tomography (PET) using 2-18f fluorine-2-deoxy-D-glucose, PET/CT, scintigraphy using technetium 99m or indium 111). Tissue biopsy remains the “gold standard” of diagnosis. 

Key words

diabetes mellitus, neuroosteoarthropathy, Charcot foot, osteomyelitis, visualization, positron emission tomography, biopsy 

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1. Rahman N.A., Fauzi A.A., Chung T.Y., Latif L.A, Chan S.C. Foot ulcers and their association with diabetic Charcot foot complications. Aust J Gen Pract. 2020;49(1-2):48–53.
2. Liu G.L., Yang B.K., Dong H.R. Diagnosis and treatment of Charcot's osteoarthropathy. Zhongguo Gu Shang. 2019;32(12):1168–1172.
3. Vileikyte L., Pouwer F., Gonzalez J.S. Psychosocial research in the diabetic foot: Are we making progress? Diabetes Metab Res Rev. 2019:3257.
4. Sinacore D.R., Smith K.E., Bohnert K.L., Gutekunst D.J., Johnson J.E., Strube M.J. Accelerated Cortical Osteolysis of Metatarsals in Charcot Neuroarthropathy: A Cross-Sectional Observational Study. JBMR Plus. 2019;3(12):10243.
5. Malik R.A. Diabetic neuropathy: A focus on small fibres. Diabetes Metab Res Rev. 2019;12:3255.
6. Badedi M., Darraj H., Hummadi A., Solan Y., Zakri I., Khawaji A., Daghreeri M., Budaydi A. Vitamin B (12) Deficiency and Foot Ulcers in Type 2 Diabetes Mellitus: A Case-Control Study. Diabetes Metab Syndr Obes. 2019;12:2589–2596.
7. Frykberg R.G., Wukich D.K., Kavarthapu V., Zgonis T., Dalla Paola L. Board of the Association of Diabetic Foot Surgeons. Surgery for the diabetic foot: A key component of care. Diabetes Metab Res Rev. 2019;10:3251.
8. Kim Y.K., Lee H.S., Seo S.G., Park S.H., Boedijono D. Results of Simple Conservative Treatment of Midfoot Charcot Arthropathy. Clin Orthop Surg. 2019;11(4):459–465.
9. Walker E.A., Beaman F.D., Wessell D.E. [et al.]. Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria Suspected Osteomyelitis of the Foot in Patients With Diabetes Mellitusn. J Am Coll Radiol. 2019;16(11):440–450.
10. Cates N.K., Elmarsafi T., Bunka T.J. [et al.]. Peripheral Vascular Disease Diagnostic Related Outcomes in Diabetic Charcot Reconstruction. J Foot Ankle Surg. 2019;58(6):1058–1063.
11. Zakin E., Abrams R., Simpson D.M. Diabetic Neuropathy. Semin Neurol. 2019;39(5):560–569.
12. Wilson J.T., Pitts C., Hess M., Phillips S.G., Siegal G.P., Johnson M.D. Extraskeletal Myxoid Chondrosarcoma of the Midfoot Presenting as Charcot Arthropathy: A Case Report. JBJS Case Connect. 2019;9(4):458.
13. Ababneh A., Bakri F.G., Khader Y., Lazzarini P., Ajlouni K. Prevalence and Associates of Foot Deformities among Patients with Diabetes in Jordan. Curr Diabetes Rev. 2020;16(5):471–482.
14. Dharmadas S., Kumar H., Pillay M., Jojo A., Tessy P.J., Sukumaran Mangalanandan T., Vivek L., Pavithran Praveen V., Bal A. Microscopic study of chronic charcot arthropathy foot bones contributes to understanding pathogenesis – A preliminary report. Histol Histopathol. 2019;35(5):18162.
15. Sun Y., Gao Y., Chen J., Sun H., Cai Y. T., Ge L., Li Y.N., Zhang J., Tian J.H. Evidence mapping of recommendations on diagnosis and therapeutic strategies for diabetes foot: an international review of 22 guidelines. Metabolism. 2019;100:153956.
16. Tan A.L., Greenstein A., Jarrett S.J. [et al.]. Acute neuropathic joint disease: a medical emergency? Diabetes Care. 2005;28(12):2962–2964.
17. Heidari N., Oh I., Li Y., Vris A., Kwok I., Charalambous A., Rogero R. What Is the Best Method to Differentiate Acute Charcot Foot From Acute Infection? Foot Ankle Int. 2019;40:39–42.
18. Armstrong D.G., Lavery L.A. Monitoring healing of acute Charcot’s arthropathy with infrared dermal thermometry. J Rehabil Res Dev. 1997;34:317–321.
19. Schmidt B.M., Allison S., Wrobel J.S. Describing Normative Foot Temperatures in Patients With Diabetes-Related Peripheral Neuropathy. J Diabetes Sci Technol. 2020;14(1):22–27.
20. Guariguata L., Whiting D.R., Hambleton I., Beagley J., Linnenkamp U., Shaw J.E. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–149.
21. Dodd A., Daniels T.R. Charcot Neuroarthropathy of the Foot and Ankle. J Bone Joint Surg Am. 2018;100(8):696–711.
22. Trieb K. Charcot foot. Orthopade. 2015;44(1):1.
23. SaiPrathiba A., Senthil G., Juttada U., Selvaraj B., Kumpatla S., Viswanathan V. RANKL Gene Polymorphism as a Potential Biomarker to Identify Acute Charcot Foot Among Indian Population With Type 2 Diabetes: A Preliminary Report. Int J Low Extrem
Wounds. 2019;18(3):287–293.
24. Wanzou J.P.V., Sekimpi P., Komagum J.O., Nakwagala F., Mwaka E.S. Charcot arthropathy of the diabetic foot in a sub-Saharan tertiary hospital: a cross-sectional study. J Foot Ankle Res. 2019;12:33.
25. Wukich D.K., Raspovic K.M., Hobizal K.B. [et al.] Radiographic analysis of diabetic midfoot Charcot neuroarthropathy with and without midfoot ulceration. Foot Ankle Int. 2014;35:1108–1115.
26. Levitt B.A., Stapleton J.J., Zgonis T. Diabetic Lisfranc fracture-dislocations and Charcot neuroarthropathy. Clin Podiatr Med Surg. 2013;30:257–263.
27. Wang G.L., Zhao K., Liu Z.F. [et al.]. A meta-analysis of fluorodeoxyglucose-positron emission tomography versus scintigraphy in the evaluation of suspected osteomyelitis. Nucl Med Commun. 2011;32:1134–1142.
28. Kučera T., Grinac M., Valtr O., Šponer P. Mid-Term Outcomes of Reconstruction of Charcot Foot Neuroarthropathy in Diabetic Patients. Acta Chir Orthop Traumatol Cech. 2019;86(1):51–57.
29. Jeffcoate W. The causes of the Charcot syndrome. Clin Podiatr Med Surg. 2008;25:29–42.
30. Tan P.L., The J. MRI of the diabetic foot: differentiation of infection from neuropathic change. Br J Radiol. 2007;80:939–948.
31. Petrova N.L., Petrov P.K., Edmonds M.E., Shanahan C.M. Inhibition of TNF-α reverses the pathological resorption pit profile of osteoclasts from patients with acute Charcot osteoarthropathy. J Diabetes Res. 2015;2015:917–945.
32. Anthony M.L., Cravey K.S., Atway S.A. Development of Charcot Neuroarthropathy in Diabetic Patients who Received Kidney or Kidney-Pancreas Transplants. J Foot Ankle Surg. 2019;58(3):475–479.
33. Familiari D., Glaudemans A. W., Vitale V. [et al.]. Can sequential 18F-FDG PET/CT re-place WBC imaging in the diabetic foot? J Nucl Med. 2011;52(7):1012–1019.
34. Higgins A., Teixeira M., Szostek J.H. 58-Year-Old Diabetic Man With a Warm, Erythematous Foot. Mayo Clin Proc. 2019;94(3):526–530.
35. Pitocco D., Scavone G., Di Leo M., Vitiello R., Rizzi A., Tartaglione L., Costantini F., Flex A., Galli M., Caputo S., Ghirlanda G., Pontecorvi A. Charcot Neuroarthropathy: From the Laboratory to the Bedside. Curr Diabetes Rev. 2019;16(1):62–72.
36. Leone A., Vitiello C., Gullì C., Sikora A.K., Macagnino S., Colosimo C. Bone and soft tissue infections in patients with diabetic foot. Radiol Med. 2020;125(2):177–187.
37. Lymbouris M., Gooday C., Dhatariya K.K. Mitochondrial dysfunction is the cause of one of the earliest changes seen on magnetic resonance imaging in Charcot neuroarthopathy - Oedema of the small muscles in the foot. Med Hypotheses. 2020;134:109439.
38. Waibel F.W.A., Uçkay I., Sairanen K., Waibel L., Berli M.C., Böni T., Gariani K., Lipsky B.A. Diabetic calcaneal osteomyelitis. Infez Med. 2019;27(3):225–238.
39. Boulton A.J.M. The pathway to foot ulceration in diabetes. Med Clin North Am. 2013;97(5):775–790. doi:10.1016/j.mcna.2013.03.007
40. Lee C.S., Divi S.N., Dirschl D.R., Hynes K.K. Financial Impact of Magnetic Resonance Imaging in the Surgical Treatment of Foot and Ankle Osteomyelitis. J Foot Ankle Surg. 2020;59(1):69–74.
41. Senneville E.M., Lipsky B.A., van Asten S.A.V., Peters E.J. Diagnosing diabetic foot osteomyelitis. Diabetes Metab Res Rev. 2020;36(S1):3250.
42. Roug I.K., Pierre-Jerome C. MRI spectrum of bone changes in the diabetic foot. Eur J Radiol. 2012;81(7):1625–1629.
43. Ergen F.B., Sanverdi S.E., Oznur A. Charcot foot in diabetes and an update on imaging. Diabet Foot Ankle. 2013;4:21884.
44. Aicale R., Cipollaro L., Esposito S., Maffulli N. An evidence based narrative review on treatment of diabetic foot osteomyelitis. Surgeon. 2020;18(5):311–320.
45. Kolosunin I., Bazina K., Kozlov S., Rodin O. Some aspects of sepsis diagnosis (a literature review). Sovremennaya nauka: aktual'nye problemy teorii i praktiki. Ser.:
Estestvennye i Tekhnicheskie nauki = Modern science: topical issues of theory and practice. Series: Natural and Technical Sciences. 2019;6(2):141–146. (In Russ.)
46. Ertugrul B.M, Savk O., Ozturk B., Cobanoglu M., Oncu S., Sakarya S. The diagnosis of diabetic foot osteomyelitis: examination findings and laboratory values. Med Sci Monit. 2009;15(6):CR307–312.
47. Labovitz J.M., Day D. The Biomechanics of Diabetes Mellitus and Limb Preservation. Clin Podiatr Med Surg. 2020;37(1):151–169.
48. Butalia S., Palda V.A., Sargeant R.J., Detsky A.S., Mourad O. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA. 2008;299(7):806–813.
49. Grünerbel A. Prevention of Diabetic Foot - from scheduled examinations via surgical procedures to footwear. MMW Fortschr Med. 2019;161(21-22):65–68.
50. Vartanians V.M., Karchmer A.W., Giurini J.M., Rosenthal D.I. Is there a role for imaging in the management of patients with diabetic foot? Skeletal Radiol. 2009;38(7):633–636.
51. Gao L., Wang J., Yin Y. Interpretation of 2019 International Working Group on Diabetic Foot guidelines on the prevention and management of diabetic foot disease. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020;34(1):16–20.
52. Leone A., Cassar-Pullicino V.N., Semprini A., Tonetti L., Magarelli N., Colosimo C. Neuropathic osteoarthropathy with and without superimposed osteomyelitis in patients with a diabetic foot. Skeletal Radiol. 2016;45(6):735–754.


Дата создания: 24.08.2021 14:55
Дата обновления: 27.08.2021 12:38