Location
Suwanee, GA
Start Date
17-4-2026 12:00 PM
End Date
17-4-2026 1:00 PM
Description
Introduction:
Charcot neuroarthropathy (CNO) is a chronic inflammatory disorder characterized by
progressive destruction of bone and joint structures, most commonly involving the foot and ankle in patients with underlying peripheral neuropathy. Diabetes mellitus is the most common associated condition, although CNO has also been reported in other neuropathic disorders. Diagnosis is frequently delayed because early CNO can mimic conditions such as cellulitis,deep venous thrombosis, inflammatory arthropathy, fractures, or ankle sprains. Physiological changes during pregnancy and the postpartum period may further obscure clinical recognition, increasing the risk of CNO.
Case Description:
A 37-year-old woman with type 2 diabetes mellitus presented during pregnancy and postpartum with progressive right foot and ankle pain and swelling. Initial evaluation at an outside facility, including plain radiographs and venous Doppler ultrasound, was unrevealing. Over subsequent months, her symptoms worsened. Physical examination demonstrated diffuse swelling, erythema, and warmth of the right foot without skin breakdown or trauma. Magnetic resonance imaging revealed extensive subchondral bone marrow edema, cortical irregularity, fragmentation of the talus, calcaneus, and midfoot articulations, and partial collapse of the tarsal
architecture, consistent with acute Charcot neuroarthropathy (Eichenholtz stage I–II). The patient was treated with strict non-weight-bearing immobilization, glycemic optimization, and pain management.
Discussion:
CNO is caused by a dysregulation in the inflammatory cascade in the setting of peripheral neuropathy, leading to repetitive microtrauma, osteoclast-mediated bone resorption, and progressive mechanical instability. Pro-inflammatory cytokines, such as tumor necrosis factor-α and interleukin-1β, activate the RANK/RANKL signaling pathway, accelerating bone destruction. In pregnancy, elevated estrogen and relaxin levels may further affect bone, tendon, and ligament integrity by altering collagen synthesis and increasing connective tissue laxity, potentially exacerbating biomechanical instability in neuropathic patients and increasing susceptibility to CNO.
Conclusions:
This case highlights the diagnostic challenges of CNO in pregnant and postpartum patients with diabetes mellitus. Clinicians should maintain a high index of suspicion for CNO in patients presenting with unexplained foot or ankle pain and swelling, even when initial imaging is unrevealing. Early recognition and prompt immobilization are critical to preventing irreversible deformity, long-term disability, and limb-threatening complications.
Introduction:
Charcot neuroarthropathy (CNO) is a chronic inflammatory disorder characterized by
progressive destruction of bone and joint structures, most commonly involving the foot and
ankle in patients with underlying peripheral neuropathy. Diabetes mellitus is the most common
associated condition, although CNO has also been reported in other neuropathic disorders.
Diagnosis is frequently delayed because early CNO can mimic conditions such as cellulitis,
deep venous thrombosis, inflammatory arthropathy, fractures, or ankle sprains. Physiological
changes during pregnancy and the postpartum period may further obscure clinical recognition,
increasing the risk of CNO.
Case Description:
A 37-year-old woman with type 2 diabetes mellitus presented during pregnancy and postpartum
with progressive right foot and ankle pain and swelling. Initial evaluation at an outside facility,
including plain radiographs and venous Doppler ultrasound, was unrevealing. Over subsequent
months, her symptoms worsened. Physical examination demonstrated diffuse swelling,
erythema, and warmth of the right foot without skin breakdown or trauma. Magnetic resonance
imaging revealed extensive subchondral bone marrow edema, cortical irregularity,
fragmentation of the talus, calcaneus, and midfoot articulations, and partial collapse of the tarsal
architecture, consistent with acute Charcot neuroarthropathy (Eichenholtz stage I–II). The
patient was treated with strict non-weight-bearing immobilization, glycemic optimization, and
pain management.
Discussion:
CNO is caused by a dysregulation in the inflammatory cascade in the setting of peripheral
neuropathy, leading to repetitive microtrauma, osteoclast-mediated bone resorption, and
progressive mechanical instability. Pro-inflammatory cytokines, such as tumor necrosis factor-α
and interleukin-1β, activate the RANK/RANKL signaling pathway, accelerating bone destruction.
In pregnancy, elevated estrogen and relaxin levels may further affect bone, tendon, and
ligament integrity by altering collagen synthesis and increasing connective tissue laxity,
potentially exacerbating biomechanical instability in neuropathic patients and increasing
susceptibility to CNO.
Conclusions:
This case highlights the diagnostic challenges of CNO in pregnant and postpartum patients with
diabetes mellitus. Clinicians should maintain a high index of suspicion for CNO in patients
presenting with unexplained foot or ankle pain and swelling, even when initial imaging is
unrevealing. Early recognition and prompt immobilization are critical to preventing irreversible
deformity, long-term disability, and limb-threatening complications.
Embargo Period
6-2-2026
Included in
A Misdiagnosis of Charcot Foot: A Case Report
Suwanee, GA
Introduction:
Charcot neuroarthropathy (CNO) is a chronic inflammatory disorder characterized by
progressive destruction of bone and joint structures, most commonly involving the foot and ankle in patients with underlying peripheral neuropathy. Diabetes mellitus is the most common associated condition, although CNO has also been reported in other neuropathic disorders. Diagnosis is frequently delayed because early CNO can mimic conditions such as cellulitis,deep venous thrombosis, inflammatory arthropathy, fractures, or ankle sprains. Physiological changes during pregnancy and the postpartum period may further obscure clinical recognition, increasing the risk of CNO.
Case Description:
A 37-year-old woman with type 2 diabetes mellitus presented during pregnancy and postpartum with progressive right foot and ankle pain and swelling. Initial evaluation at an outside facility, including plain radiographs and venous Doppler ultrasound, was unrevealing. Over subsequent months, her symptoms worsened. Physical examination demonstrated diffuse swelling, erythema, and warmth of the right foot without skin breakdown or trauma. Magnetic resonance imaging revealed extensive subchondral bone marrow edema, cortical irregularity, fragmentation of the talus, calcaneus, and midfoot articulations, and partial collapse of the tarsal
architecture, consistent with acute Charcot neuroarthropathy (Eichenholtz stage I–II). The patient was treated with strict non-weight-bearing immobilization, glycemic optimization, and pain management.
Discussion:
CNO is caused by a dysregulation in the inflammatory cascade in the setting of peripheral neuropathy, leading to repetitive microtrauma, osteoclast-mediated bone resorption, and progressive mechanical instability. Pro-inflammatory cytokines, such as tumor necrosis factor-α and interleukin-1β, activate the RANK/RANKL signaling pathway, accelerating bone destruction. In pregnancy, elevated estrogen and relaxin levels may further affect bone, tendon, and ligament integrity by altering collagen synthesis and increasing connective tissue laxity, potentially exacerbating biomechanical instability in neuropathic patients and increasing susceptibility to CNO.
Conclusions:
This case highlights the diagnostic challenges of CNO in pregnant and postpartum patients with diabetes mellitus. Clinicians should maintain a high index of suspicion for CNO in patients presenting with unexplained foot or ankle pain and swelling, even when initial imaging is unrevealing. Early recognition and prompt immobilization are critical to preventing irreversible deformity, long-term disability, and limb-threatening complications.
Introduction:
Charcot neuroarthropathy (CNO) is a chronic inflammatory disorder characterized by
progressive destruction of bone and joint structures, most commonly involving the foot and
ankle in patients with underlying peripheral neuropathy. Diabetes mellitus is the most common
associated condition, although CNO has also been reported in other neuropathic disorders.
Diagnosis is frequently delayed because early CNO can mimic conditions such as cellulitis,
deep venous thrombosis, inflammatory arthropathy, fractures, or ankle sprains. Physiological
changes during pregnancy and the postpartum period may further obscure clinical recognition,
increasing the risk of CNO.
Case Description:
A 37-year-old woman with type 2 diabetes mellitus presented during pregnancy and postpartum
with progressive right foot and ankle pain and swelling. Initial evaluation at an outside facility,
including plain radiographs and venous Doppler ultrasound, was unrevealing. Over subsequent
months, her symptoms worsened. Physical examination demonstrated diffuse swelling,
erythema, and warmth of the right foot without skin breakdown or trauma. Magnetic resonance
imaging revealed extensive subchondral bone marrow edema, cortical irregularity,
fragmentation of the talus, calcaneus, and midfoot articulations, and partial collapse of the tarsal
architecture, consistent with acute Charcot neuroarthropathy (Eichenholtz stage I–II). The
patient was treated with strict non-weight-bearing immobilization, glycemic optimization, and
pain management.
Discussion:
CNO is caused by a dysregulation in the inflammatory cascade in the setting of peripheral
neuropathy, leading to repetitive microtrauma, osteoclast-mediated bone resorption, and
progressive mechanical instability. Pro-inflammatory cytokines, such as tumor necrosis factor-α
and interleukin-1β, activate the RANK/RANKL signaling pathway, accelerating bone destruction.
In pregnancy, elevated estrogen and relaxin levels may further affect bone, tendon, and
ligament integrity by altering collagen synthesis and increasing connective tissue laxity,
potentially exacerbating biomechanical instability in neuropathic patients and increasing
susceptibility to CNO.
Conclusions:
This case highlights the diagnostic challenges of CNO in pregnant and postpartum patients with
diabetes mellitus. Clinicians should maintain a high index of suspicion for CNO in patients
presenting with unexplained foot or ankle pain and swelling, even when initial imaging is
unrevealing. Early recognition and prompt immobilization are critical to preventing irreversible
deformity, long-term disability, and limb-threatening complications.