Sonographic features of active Charcot neuro-osteoarthropathy: A case series

Aims: To describe the sonographic features of active Charcot neuro-osteoarthropathy (CNO) and assess the potential role of ultrasound in identifying those with active CNO. Methods: Using a prospective case-series study design we assessed the sonographic features of 14 patients with a diagnosis of diabetes presenting with clinical signs and symptoms suspicious for active CNO. Patients had standard weight-bearing plain X-Ray and, where possible, MRI to evaluate the presence of active CNO. Ultrasound was performed bilaterally to assess for subcutaneous oedema, intra-articular and peri-articular colour flow. The spectral waveform morphology, peak systolic velocity and resistive index of the dorsalis pedis arteries of both feet were also documented. Results: Following clinical and radiological (X-ray and MRI) assessment, 50% (n = 7) were diagnosed with active CNO. Of those with a confirmed diagnosis, ≥3 sonographic features suggestive of active CNO were observed. Conclusions: Ultrasound combined with clinical presentation and medical history may support decision making around the diagnosis of CNO at the bedside.