Abstract
ABSTRACT Background: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. Study design: Retrospective observational study, chart review Material and methods: Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment. Only cases without concomitant infection or skin ulcer were chosen, in whom both was documented, onset of symptomatic foot swelling and patient compliance with cast treatment. Results: From 1994 to 2017, 45 consecutive cases in 37 patients were retrieved, with 95 MRI follow-up studies (1–6 per case, average interval between studies 13 weeks). Decreasing EESC was documented in 66/95 (69%) follow-up studies. However, 29/95 (31%) studies revealed temporarily increasing, migrating or stagnating EESC. Conclusion: EESC on MRI disappear in response to prolonged offloading and immobilizing treatment; however, physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images. Conventional MRI is useful for surveillance of active-stage Charcot foot recovery.
Highlights
Magnetic resonance imaging (MRI) in recent years has become state of the art for diagnosing the activestage Charcot foot in patients lacking pedal nociception
equivalent signal-changes (EESC) on magnetic resonance imaging (MRI) disappear in response to prolonged offloading and immobilizing treatment; physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images
Conventional MRI is useful for surveillance of active-stage Charcot foot recovery
Summary
Magnetic resonance imaging (MRI) in recent years has become state of the art for diagnosing the activestage Charcot foot in patients lacking pedal nociception (neuro-osteoarthropathy). The potential of MRI for monitoring the treatment response, as yet has not received much attention [1,2,3,4,5] For this purpose, clinicians still prefer symptoms and plain x-ray, which is insufficient, because Charcot patients cannot communicate pain-mediated corollaries of treatment, and x-ray cannot disclose subtle acute injuries of the foot skeleton [6]. Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic
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