Neuropathic arthropathy in patients with diabetes involves the forefoot (metatarsophalangeal and interphalangeal joints), tarsometatarsal joint (Lisfranc's joint), and hindfoot (subtalar and ankle joints). 7 Neuropathic changes are still best detected by plain radiography, although early changes may be more easily diagnosed with MRI or suggested with bone scanning. Neuropathic arthropathy is destructive joint changes caused by diminished pain sensation and proprioception that leaves the joint without protection from repeated microtrauma during continued activity. Plain radiography AP, lateral, oblique, and Harris-Beath view Nuclear medicine imaging bone scan (if MRI cannot be performed) Nuclear medicine imaging bone scan (if plain films are not diagnostic)ĬT (especially for follow-up of healing fractures) Ultrasonography (can be used in place of MRI, with proper expertise) Plain radiography AP and lateral with or without oblique Plain radiography AP, lateral, and oblique Mass in the tarsal tunnel synovial hypertrophy in tarsal tunnel Limitation of motion pain and tenderness in affected areaĬallus formation fracture line periosteal reactionīilateral in 50 percent of patients restricted subtalar motion rigid, painful flatfoot valgus deformity of the hindfootĬ sign flattening and broadening of the lateral talar process narrowing of the talocalcaneal joint talar breakingĭiffuse burning pain and paresthesias along the plantar surface of the foot and toes Often asymptomatic pain in the involved web space that often radiates to the toesĪccessory tarsal navicular bones occur at the medial and posterior margins of the tarsal navicular, and os trigonum occurs adjacent to the posterior margin of the talus pain and tenderness in the affected areaįascial tear marrow edema plantar calcaneal spurĭiminished motor function pain and tenderness swelling vasomotor instabilityĭiffuse osteopenia increased tracer uptake Pain, tenderness, swelling, and limitation of motion in the affected metatarsophalangeal jointĬollapse, cystic changes, and flattening of the metatarsophalangeal joint sclerosis Fatigue joint deformity joint pain that is often symmetrical swellingĮrosion fragmentation joint space narrowing soft-tissue swellingĪvascular necrosis of the metatarsal head (Freiberg's disease)
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