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DIABETIC FOOT PLAIN
RADIOGRAPHY AND MRI
EVALUATION
A. BINTOUDI
CONSULTANT RADIOLOGIST
MSK DEPARTMENT
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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.
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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.
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Classification
Location
Forefoot,
Midfoot (most common) ,
Hindfoot
Atrophic or hypertrophic
Radiographic finding
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Complications in Diabetic Foot
Cellulitis, soft tissue edema
Septic arthritis- tendosynovitis
Abscess
Ulcer-fistula
Osteomyelitis
Gangrene
Charcot joint
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Plain radiography
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ΟΡΘΙΑ
Mild deformities
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Acute osteomyelitis
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Neuropathic
arthropathy
"Charcot foot”
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Sever Charcot joint
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Τ1WI
51 y
fistula, ulcer of great toe
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STIR
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Τ1WI
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Τ1WI+C
Negative for
osteomyelitis
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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
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OSTEOMYELITIS
2 stages
Initial stage bone marrow edema
Advanced stage infection and bone
distruction
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39 y, fistula, soft tissue edema of great toe
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Τ1WI
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Τ1WI+C
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STIR
Osteomyelitis
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42y, soft tissue edema dorsal side
midfood
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Τ1WI
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Τ1WI+C
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Osteomyelitis
STIR
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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.
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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
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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
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CHARCOT FOOT
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STIR
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Τ1WI+C
Τ1WI+C
Τ1WI
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CHARCOT JOINT
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T1WI
STIR
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NEUROPATHIC ARTHRITIS CHARCOT
CHRONIC STAGE
ADDITIONALLY
• Soft tissue edema
• Fluid collection at the ankle
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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
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Thank you!!!