DIABETIC FOOT PLAIN

RADIOGRAPHY AND MRI

EVALUATION

A. BINTOUDI

CONSULTANT RADIOLOGIST

MSK DEPARTMENT

The World Health Organization has predicted

that there will be 380 million diagnosed

diabetics worldwide by 2025. Africa will face

the second highest increase in prevalence of

the disease – an expected increase of 160%,

second only to the increased prevalence

expected in the Middle East. This predicted

increase equates to 760 million feet at risk of

possible ulceration.

Foot complications in diabetics often

lead to amputation. Ulceration is the

most common complication in the

diabetic forefoot and underlines more

than 90% of cases of pedal

osteomyelitis. Plain radiography is the

first choice giving anatomic

information but it is not specific or

sensitive. Gold standard method for

diabetic foot evaluation is MRI and

Bone Scan.

Classification

Location

Forefoot,

Midfoot (most common) ,

Hindfoot

Atrophic or hypertrophic

Radiographic finding

Complications in Diabetic Foot

Cellulitis, soft tissue edema

Septic arthritis- tendosynovitis

Abscess

Ulcer-fistula

Osteomyelitis

Gangrene

Charcot joint

Plain radiography

ΟΡΘΙΑ

Mild deformities

Acute osteomyelitis

Neuropathic

arthropathy

"Charcot foot”

Sever Charcot joint

Τ1WI

51 y

fistula, ulcer of great toe

STIR

Τ1WI

Τ1WI+C

Negative for

osteomyelitis

One of the most common complication among patients with

diabetic foot (>15%).

Infection of soft tissues can spread to bone marrow provoking

osteomyelitis.

The most frequent sides of the foot that suffer from infection

are head of metatarsal bones and calcaneus .This is due to the

fact that the respective anatomical parts accept more pressure.

Soft tissue infection and osteomyelitis is a combination of

diabetic microangiopathy and diabetic peripheral neuropathy .

OSTEOMYELITIS

OSTEOMYELITIS

2 stages

Initial stage bone marrow edema

Advanced stage infection and bone

distruction

39 y, fistula, soft tissue edema of great toe

Τ1WI

Τ1WI+C

STIR

Osteomyelitis

42y, soft tissue edema dorsal side

midfood

Τ1WI

Τ1WI+C

Osteomyelitis

STIR

Charcot's joints, also called neuropathic joint

disease, is the result of two conditions present in

the joint. The first factor is the inability to feel pain

in the joint due to nerve damage. The second

factor is that injuries to the joint go unnoticed

leading to instability and making the joint more

susceptible to further injury. Repeated small

injuries, strains and even fractures could be

unnoticed until the joint is permanently destroyed.

Loss of the protective sensation of pain is what

leads to the disintegration of the joint and often

leads to deformity in the joint.

NEUROPATHIC ARTHRITIS

CHARCOT

RADIOLOGIC FINDINGS

Soft tissue edema

Degeneration of articular cartilage

stenosis

Fractures and distortion of articular surfaces

Bone hypertrophy and hyperostosis

Subluxation

JOINT IS COMPLETELY

DESTROYED

NEUROPATHIC ARTHRITIS CHARCOT

severe deformities

Disorganization, destruction of articular

surfaces and dislocation of the midfoot bones

Low MR sign in all sequences due to

osteosclerosis

Cystic bone lesions ( Τ1WI , T2WI)

Osteomyelitis is excluded

CHARCOT FOOT

STIR

Τ1WI+C

Τ1WI+C

Τ1WI

CHARCOT JOINT

T1WI

STIR

NEUROPATHIC ARTHRITIS CHARCOT

CHRONIC STAGE

ADDITIONALLY

• Soft tissue edema

• Fluid collection at the ankle

Conclusion

Multi-disciplinary approach needed

Going to be an increasing problem

High morbidity and cost

Solution is probably in prevention

Most feet can be spared…at least for a while

Thank you!!!