Imaging challenges in Charcot’s neuroarthropathy and diabetic foot: Distinguishing infective and non-infective conditions

Charcot neuroarthropathy (CN) is a polyneuropathy-based inflammatory pedal disease. It is most commonly reported in patients with diabetes mellitus, and in spite of dating back to the 1800s, its exact pathophysiology, diagnosis, and treatment remain under discussion. The term “diabetic foot” occurs in individuals who have a combination of peripheral neuropathy, peripheral vascular disease, and immunopathy as a result of longstanding poor glycemic control, leading to CN, ulcerations, and also infection and diabetic foot osteomyelitis (DFO) can complicate the disease even further. It is imperative to make a timely diagnosis of DFO as infection will need aggressive antimicrobial and often surgical management, and a delay in diagnosis can lead to higher-level amputation due to ascending infection and systemic complications such as sepsis and multiorgan failure. Conversely, for uncomplicated CN, the management is primarily offloading and immobilization with stricter glycemic control. The purpose of this review is to elaborate on the imaging of Charcot’s foot and to differentiate between uninfected CN and DFO for optimal clinical and surgical management.