Charcot's neuroarthropathy of the foot in a diabetic patient is best described radiographically in the active (acute inflammatory) phase by which finding?

• A Widespread osteopenia with periosteal reaction and no fragmentation
• B Uniform joint space narrowing with subchondral sclerosis and marginal osteophytes
• C Lytic lesion of the metatarsal shaft with periosteal elevation suggesting osteomyelitis
• D Disorganised joint destruction, bone fragmentation, periarticular sclerosis, and new bone formation (the '5 Ds': density, destruction, debris, disorganisation, dislocation) ✓

Explanation

Active Charcot neuroarthropathy produces the classic '5 Ds' on radiograph — increased bone Density (eburnation), Destruction of joint, Debris (osseous fragments), Disorganisation of the joint architecture, and Dislocation. The midfoot (Lisfranc joint) is most commonly affected in diabetics. Acute Charcot presents with warmth, swelling, and erythema mimicking infection; absence of fever and negative bone culture differentiate it. Treatment is total contact casting to off-load the foot.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.