# Charcot Neuroarthropathy Masquerading as Severe Acute Orthopedic Trauma: Severe Ramifications of Untreated Diabetes Mellitus

## TL;DR

A case of Charcot neuroarthropathy mistaken for severe ankle trauma highlights the importance of early diagnosis in diabetes-related complications.

## Contribution

This case emphasizes the need for considering Charcot neuroarthropathy in trauma-like presentations, even without a known diabetes history.

## Key findings

- Charcot neuroarthropathy can mimic severe orthopedic trauma, leading to misdiagnosis.
- Early diagnosis and immobilization prevented further joint destruction and complications.
- Uncontrolled diabetes can present without a documented medical history, complicating diagnosis.

## Abstract

Charcot neuroarthropathy (CNA) is a progressively debilitating condition characterized by joint destruction and deformity due to neuropathy and mechanical trauma. It is most seen in patients with uncontrolled diabetes mellitus and resulting secondary peripheral neuropathy. Misdiagnosis is common, as the initial presentation of erythema, swelling, and warmth can mimic conditions such as cellulitis or osteomyelitis, and radiographic images may resemble that of severe trauma. Early recognition is crucial to prevent complications, including chronic deformity, ulceration, and amputation. In this case, a 42-year-old male patient with no documented medical history presented to the emergency department (ED) with worsening left ankle and foot pain after rolling his ankle on a flat surface. Imaging revealed acute, intra-articular fractures of the left hindfoot involving the talus, cuboid, navicular, and lateral cuneiform, with associated joint dislocations and severe soft tissue edema. These findings, initially concerning for severe limb trauma, in fact, represented that of CNA after underlying uncontrolled diabetes mellitus was diagnosed. While CNA is most commonly associated with diabetic peripheral neuropathy, it should not be excluded in the absence of a documented medical history of diabetes mellitus. Given the potential for misdiagnosis, early collaboration among specialists was essential in providing the patient with an accurate clinical determination. Early immobilization and offloading prevented further joint destruction, highlighting the critical role of early intervention in mitigating long-term complications such as chronic deformity or amputation.