A 60-year-old diabetic man with peripheral neuropathy notices a warm, swollen, erythematous midfoot after minor trauma. Radiographs are essentially normal. Skin is intact and pedal pulses are palpable. Laboratory tests show no leukocytosis. The immediate management is:

• A Immediate weight bearing in a prefabricated walking brace
• B Surgical fixation with locked plating across the midfoot
• C Strict nonweight bearing with a total contact cast until swelling and warmth resolve ✓
• D IV antibiotics pending bone scan

Explanation

This is acute Charcot neuroarthropathy, likely Eichenholtz stage 0 or I. The cornerstone of treatment in the active hot phase is immobilization and complete offloading, conventionally a total contact cast, continued until the limb cools and enters the coalescence phase, because weight bearing on insensitive inflamed joints accelerates fragmentation and deformity. Operating during the active phase carries high failure rates, making option B wrong. Weight bearing in a brace, option A, defeats the purpose. Intact skin, palpable pulses, and absent septic signs argue against infection.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.