Charcot foot (pied de Charcot) (CF), first described by Jean-Martin Charcot in 1868, is caused by a wide variety of disorders that ultimately destroy the protective mechanisms of the small joints of the foot. Leprosy and diabetes are the most common causes of this form of destructive neuroarthropathy in the developing world. Although the prevalence of Charcot’s neuroarthropathy (CN) in diabetes is <0.5% in the Western world (1), we believe the incidence is much higher in our patient population in India. If the diagnosis is missed early in the natural course of the disease, severe foot deformity and disability, ulceration, infection, and ultimately limb amputation are the expected outcomes. Five distinct patterns of involvement have been described in people with diabetes presenting with CF (2). In this article, we share clinical and radiological photographs of each of these subtypes through five case presentations of patients with longstanding diabetes and clinical evidence of advanced peripheral neuropathy in the absence of peripheral vascular disease.
A 71-year-old man with type 2 diabetes presented with swelling of the left great toe and a discharging, nonhealing ulcer on its plantar aspect (Figure 1). Clinical and radiological examinations were suggestive of osteomyelitis of the left great toe. However, we also noticed mid- and forefoot widening on the right side. X-ray of the right foot revealed “pencil-in-cup deformity” involving the first and fourth metatarso-phalangeal (MTP) joints and “sucked-candy appearance” of the second, third, and fourth metatarsals, suggestive of pattern I CF.
A 52-year-old man with a 15-year history of type 2 diabetes presented with progressive left …