Novel advanced imaging method to differentiate acute osteomyelitis from acute charcot neuroarthropathy in presence of chronic ulcer: A case report

Charcot neuroarthropathy is a degenerative disorder that compromises the structural integrity of bones and joints in neuropathic limbs, particularly affecting the foot. Patients often have concomitant ulcers making it difficult to distinguish acute charcot neuroarthropathy from underlying acute osteomyelitis (OM). This case report details a 52-year-old patient who presented to clinic with charcot neuroarthropathy with chronic ulcer. Our team utilized a sequence of 3 phases of bone scan — Technetium-99 m methyl diphosphonate (Tc-99 m MDP), Technetium-99 m sulfur colloid (Tc-99 m SC), and Indium-111 white blood cell (WBC) imaging — combined with single-photon emission computed tomography scan with a computed tomography (SPECT-CT) to delineate acute Charcot changes from acute osteomyelitis (OM). Imaging revealed soft tissue infection in the left plantar midfoot without evidence of osteomyelitis (OM), allowing patient to undergo successful staged reconstructive surgery with combination hindfoot and midfoot arthrodesis with subsequent external fixator application. This innovative imaging approach enhances the ability to differentiate acute osteomyelitis (OM) from acute charcot neuroarthropathy in presence of ulcer, guiding surgical planning prior to reconstruction.