Charcot arthropathy (neuropathic joint) most commonly affects which joint in diabetic patients, and what is the classical early radiological finding?

• A Knee joint; periarticular osteopenia with subluxation
• B Ankle joint; erosions and joint space narrowing
• C Tarsometatarsal (Lisfranc) and midfoot joints; periarticular fractures, fragmentation, and collapse on weight-bearing X-rays ✓
• D Hip joint; avascular necrosis of the femoral head

Explanation

Diabetic Charcot neuroarthropathy most commonly affects the tarsometatarsal joints (Lisfranc) and midfoot (Eichenholtz classification). The classic appearance is the 'bag of bones' pattern — periarticular fractures, fragmentation, joint subluxation/dislocation, bone resorption, and sclerosis. The Eichenholtz Stage I (development/fragmentation) shows acute inflammatory presentation with warmth, swelling, and erythema with periarticular fractures; Stage II = coalescence (repair); Stage III = consolidation (rigid deformity). Offloading with total contact casting in Stage I prevents collapse and deformity progression.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.