Charcot's osteoarthropathy or Sudeck's Syndrome? A case report
Authors:
Novák Vladimír 1,2
Authors‘ workplace:
Interní oddělení, kostní, diabetologická a endokrinologická ambulance, Klatovská nemocnice a. s., Klatovy
1; Interní, diabetologická a endokrinologická ambulance, Nemocnice Vimperk, Vimperk
2
Published in:
Clinical Osteology 2024; 29(4): 147-150
Category:
Overview
A patient (born in 1950), was examined for suspicion of Sudeck’s syndrome of the left foot. The problems arose after prolonged work in the garden – significant pain in the instep and sole, sensitivity to touch, swelling and redness up to the ankles. There was no previous fracture or other trauma, in the pre-illness the patient was fully mobile without support. Due to the sixteen-year history of type 2 diabetes mellitus, we considered Charcot’s osteoarthropathy in the differential diagnosis; Subsequently, three-phase skeletal scintigraphy and MRI of the left foot were compatible with this diagnosis, as they showed pathologically increased activity in the area of the instep of the left foot, respectively osteolytic destruction of the intermediate cuneiform bone. During treatment, the patient refused to relieve the left foot, the treatment was therefore only medicamentous. After 2 years from the onset of the symptoms, the patient is without signs of inflammatory activity, the left foot is without swelling, but with a violation of the arch and a slight deformity. In the case report we did not come to a clear diagnostic conclusion: For Charcot’s osteoarthropathy, hyperalgesia and allodynia are atypical, as was the case at the beginning of the problem, as well it was not possible to assess the effect of relieving the limb on the patient’s difficulties or on changes in MRI. We do not rule out a combination of both syndromes.
Keywords:
complex regional pain syndrome – Charcot’s osteoarthropathy – Sudeck’s syndrome – type 2 diabetes mellitus
Sources
Melf-Marzi A, Böhringer B, Wiehle M et al. Modern Principles of Diagnosis and Treatment in Complex Regional Pain Syndrome. Dtsch Arztebl Int 2022; 119(51–52), 879–886. Dostupné z DOI: <http://dx.doi.org/10.3238/arztebl.m2022.0358>.
Castillo-Guzmán S, Nava-Obregón TA, Palacios-Ríos D et al. Complex regional pain syndrome (CRPS), a review. Medicina Universitaria 2015; 17(67): 114–121. Dostupné z DOI: <http://10.1016/j.rmu.2015.03.003>.
Wukich DK, Schaper NC, Gooday C et al. Guidelines on the diagnosis and treatment of active Charcot neuro-osteoarthropathy in persons with diabetes mellitus (IWGDF 2023). Diabetes Metab Res Rev 2024; 40(3): e3646. Dostupné z DOI: <http://dx.,doi.org/10.1002/dmrr.3646>.
Jirkovská A, Fejfarová V, Dubský M et al. Jaká jsou specifika syndromu diabetické nohy a proč potřebujeme mezioborová doporučení pro jeho diagnostiku a léčbu? [What are the specifics of diabetic foot syndrome and why we need interdisciplinary recommendations for its diagnosis and treatment?] Vnitř Lék 2021; 67(8): 489–494. Dostupné z DOI: <https://doi 10.36290/vnl.2021.125>.
Poll LW, Weber P, Böhm H-J et al. Sudeck’s disease stage 1, or diabetic Charcot’s foot stage 0? Case report and assessment of the diagnostic value of MRI. Diabetol Metab Syndr 2010; 2: 60. Dostupné z DOI: <http://dx.doi.org/10.1186/1758–5996–2–60>.
Classification systems of Charcot arthropathy. Dostupné z WWW: <https://radiopaedia.org/articles/classification-systems-of-charcot-arthropathy>. Dostupné z DOI: <https://doi:10.53347/rID-181321>.
Araujo Nunes G, Levy Almeida Taveira de Souza M, Maciel Braga B et al. Osteonecrosis of the Intermediate Cuneiform: A Case Report. Rev Bras Ortop (Sao Paulo) 2020; 56(3): 394–398. Dostupné z DOI: <http://dx.doi.org/10.1055/s-0040–1715513>.
Ertugrul BM, Lipsky BA, Savk O. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem. Diabet Foot Ankle 2013; 4: 21855. Dostupné z DOI: <http://dx.doi.org/10.3402/dfa.v4i0.21855>.
Harden NR, Bruehl S, Perez RS et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome. Pain 2010; 150(2): 268–274. Dostupné z DOI: <http://dx.doi.org/10.1016/j.pain.2010.04.030>.
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Clinical biochemistry Paediatric gynaecology Paediatric radiology Paediatric rheumatology Endocrinology Gynaecology and obstetrics Internal medicine Orthopaedics General practitioner for adults Radiodiagnostics Rehabilitation Rheumatology Traumatology OsteologyArticle was published in
Clinical Osteology
2024 Issue 4
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