A 55-year-old man with poorly controlled diabetes mellitus presents with a hot, swollen, erythematous right foot with intact skin and normal laboratory markers of infection. Radiographs are essentially unremarkable, though MRI shows marrow edema without cortical destruction. The limb is sensate to deep pressure only. What is the single most important intervention at this stage?

• A Non-weight bearing immobilization in a total contact cast ✓
• B Urgent exostectomy of any bony prominence
• C Intravenous antibiotics pending bone biopsy
• D Immediate tarsometatarsal arthrodesis to prevent collapse

Explanation

The presentation is consistent with very early neuropathic arthropathy (Eichenholtz stage 0 to stage I). The cornerstone of management in the active inflammatory phase is strict offloading with a total contact cast, continued until edema and temperature difference between the feet resolve, typically several months. Surgery is generally avoided in the active phase because disordered bone turnover leads to hardware failure and progressive destruction. Infection markers are normal and skin is intact, making antibiotics inappropriate.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.