International Journal of Diabetes Mellitus
Volume 1, Issue 1 , Pages 57-58, April 2009

Lisfranc’s dislocation and fracture in the Charcot Foot

Department of Diagnostic Radiology, King Saud University, P.O. Box 7805, Riyadh, Saudi Arabia

Article Outline

Abstract 

Diabetic patients may present with Lisfranc’s Fracture Dislocation which may be confused with osteomyelitis. Rapid diagnosis and early intervention can prevent deformity. We suggest that the diagnosis of Charcot’s foot should be considered in any diabetic patient with unilateral swelling of lower extremity and/or foot.

Keywords: Lisfranc’s fracture dislocation, Diabetic foot

 

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1. Clinical presentation 

A 45 year old man was presented in the emergency department with swelling of the right foot since last 20 days. There was no history of trauma, fever or constitutional symptoms. He was a known diabetic and was on oral hypoglycemic drugs. On examination: the foot was diffusely swollen, red, warm, non tender on palpation.

X-ray of the foot was advised which revealed:

1.1. Questions 


(1)What are the radiological findings?

(2)What is the probable cause?

(3)What are the other common causes?

1.2. Answers 


(1)Dorsoplantar, oblique and lateral views of the foot reveal loss of normal alignment of second metatarsal (Number 1 in Fig. A) with middle cuneiform (Number 2 Fig. A) and lateral dislocation of second through fifth metatarsals. Flattening of the longitudinal arches is seen on lateral view (Fig. C). Note fracture at the base of second metatarsal and smaller fractures along the tarsometatarsal joints, fragmentation, bone remodeling, vascular calcifications (Number 3 in Fig. A) and swelling of the foot (Number 1 in Fig. B) suggesting Charcot Foot with Lisfranc’s fracture dislocation. Surgical clips from 15 years back surgery at the ankle joint are also visualized (Fig. B, Fig. C).

(2)Charcot Foot in a diabetic patient.

(3)Shear forces due to forced plantarflexion as in motor vehicle or parachuting accidents are among other common causes.

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2. Discussion 

Studies in the Arab World have shown a prevalence range of neuropathy from 38% to 94% in diabetic foot cases [1]. The Charcot Foot in the diabetic patients is a progressive condition that involves not only bones but also other tissues. Charcot process includes warmth, erythema and swelling [2], [3] and is often confused with osteomyelitis. Rapid diagnosis and early intervention can prevent deformity [4]. In the mid foot, Lisfranc fracture dislocation develops after initial joint swelling and ligamentous laxity. Eburnation and bony fragmentation occurs at the disorganized tarsometatarsal joints and there is collapse of the longitudinal arch. All these changes occur very rapidly with normal radiograph deteriorating badly within a span of few weeks [5]. The five D’s summarize the situation: joint distension, dislocation, debris, disorganization, and increased density. We suggest that the diagnosis of acute Charcot Foot should be considered in any patient with diabetes and unilateral swelling of the lower extremity and/or foot.

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References 

  1. Al Wahbi AM. The diabetic foot in Arab world. Saudi Med J. 2006;27(2):147–153
  2. Giurini JM, Chrzan JS, Gibbons GW, Habershaw GM. Charcot’s disease in diabetic patients. Correct diagnosis can prevent progressive deformity. Postgrad Med. 1991;89(4):163–169
  3. Holmes GB, Hill N. Fractures and dislocations of the foot and ankle in diabetics associated with Charcot joint changes. Foot Ankle Int. 1994;15:182–185
  4. Petrova NL, Edmonds ME. Charcot neuro-osteoarthropathy – current standards. Diabetes Metab Res Rev. 2008;24(Suppl. 1):S58–S61
  5. Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45:1085–1096

PII: S1877-5934(09)00010-1

doi:10.1016/j.ijdm.2009.03.006

International Journal of Diabetes Mellitus
Volume 1, Issue 1 , Pages 57-58, April 2009

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