Is There a Systemic Inflammatory Response in the Acute Charcot Foot?

Abstract

Although patients with acute Charcot osteoarthropathy exhibit a marked local inflammatory response to trauma by the classical presentation of a red, hot swollen foot, the systemic acute phase response has not been fully investigated. The aim of this study was to measure the systemic serologic markers of inflammation in acute Charcot osteoarthropathy. We studied 36 consecutive patients who presented to the Diabetic Foot Clinic over the last 5 years with a red, hot swollen foot and a skin temperature >2°C compared with the same site on the contralateral foot and who had no previous treatment. There was no evidence of any skin breakdown or ulceration. Foot skin temperatures were measured by Dermatemp 1001 (Exergen, Watertown, MA). The diagnosis of Charcot osteoarthropathy was confirmed in 25 cases by evidence of subluxation, dislocation, or fragmentation of bone on standard foot radiographs and in 11 cases by the presence of an increased focal uptake on the bony (third) phase of the triphasic Technetium-Diphosphonate bone scan (Tyco Healthcare) even though the radiographs at presentation were normal. In the patients with radiological abnormalities, the patterns of involvement were described using Sanders and Frykberg's classification (1). Four patients presented with pattern I …