Is there a systemic inflammatory response in the acute charcot foot?

RESEARCH DESIGN AND METHODS — We studied 36 consecutive patients who presented to the Diabetic Foot Clinic over the last 5 years with a red, hot swollen foot and a skin temperature 2°C compared with the same site on the contralateral foot and who had no previous treatment. There was no evidence of any skin breakdown or ulceration. Foot skin temperatures were measured by Dermatemp 1001 (Exergen, Watertown, MA). The diagnosis of Charcot osteoarthropathy was confirmed in 25 cases by evidence of subluxation, dislocation, or fragmentation of bone on standard foot radiographs and in 11 cases by the presence of an increased focal uptake on the bony (third) phase of the triphasic Technetium-Diphosphonate bone scan (Tyco Healthcare) even though the radiographs at presentation were normal. In the patients with radiological abnormalities, the patterns of involvement were described using Sanders and Frykberg’s classification (1). Four patients presented with pattern I (metatarsal-phalangeal joints), seven with pattern II (tarsometatarsal joints), four with pattern III (tarsal joints), one with pattern IV (ankle joint), and two with pattern V (calcaneum). Seven patients presented with multiple sites of involvement: six had a combination of patterns II and III, and one had patterns I and II. In the remaining 11 patients who presented with normal radiographs, there was increased focal uptake on the bony (third) phase of the triphasic Technetium Diphosphonate bone scan: 10 in the midfoot and 1 in the forefoot. These patients were similar to the Charcot foot stage 0 with normal radiograph and abnormal bone scan as described in Sella and Barrette’s staging of Charcot osteoarthropathy (2). Serum C-reactive protein (CRP), white cell count (WCC), erythrocyte sedimentation rate (ESR), Hb, and GHb were measured at presentation. Data on liver synthesis function including liver enzymes (aspartate transminase, alkaline phosphatase, and -glutamyl tranferase) and serum proteins (albumin and globulin) were also recorded. Renal function was assessed by serum creatinine levels.