Charcot arthropathy, Lisfranc disruption and sewing needle foreign body
Presentation
Foot swelling. Previous osteomyelitis.
Patient Data
Diffuse soft tissue swelling. Widening of the space between the 1st and 2nd left metatarsal bases, with lateral displacement of the 2nd to 5th metatarsals in keeping with rupture of the Lisfranc ligament. The metatarsals are generally sclerotic. There are multiple lucent, destructive foci involving all the tarsometatarsal joints, with hypertrophic bony formation on the lateral projection over this region. Small linear metallic foreign bodies within the 2nd toe.
Impression
Tarsometatarsal joints Charcot arthropathy with divergent type Lisfranc injury.
Case Discussion
The patient was a poorly controlled diabetic. The foreign body is a fractured portion of a sewing needle that the patient had no recollection of kicking or standing on. The patient did however have severe diabetic peripheral neuropathy with almost complete loss of sensation below the knees bilaterally.
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