Viva MOCK Flashcards
(4 cards)
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Patient – Young Lady Aged 15 attends your Podiatry Clinic for an assessment. She was referred to you from her GP with a red-hot swollen heel.
On examination / consultation you find out
She has had Type I diabetes from the Age of 1. Her mother says that she hasn’t had the best control of his diabetes throughout her life. It’s been difficult with her activities.
X-rays have been taken with Nothing remarkable reported from the consultant radiographer.
Neither the girl or his mother recall any injury to the area; however, she is very sporty and plays a lot of football.
Using effective diagnosing skills what would your differential diagnosis be
So firstly if we think of the Red hot swollen foot it screams out charcot. Signs and symptomns of Charcot are erythema swelling and a temprature difference of 2 degrees between the affected and the unaffcetd limb.
We know that Charcot is strongly linked with diabetes which the patient has and if we look at the pathogenesis of Charcot we can see that link clearly. So weve got that sensory neuropathy where patients have joint subluxations and microtraumas that go unoticed that leads to uncontrolled inflamtion and you end up with fractures foot deformity.
Weve also got the neurovascular theory that was propsed by** Charcot in 1868** thats centered around autonomic nerve damage so the nerves cant regulate blood flow arent working correctley so you end up with an increased blood prefusion of the bones which results in an increase in osteoclast activity so theres more bone resorption and then we end up with a decrease in bone density and resultant ostepenia. The fact that the patients blood sugars are uncontrolled is another strong link as we know that causes nerve damage.
Then if we look at the xray Gooday 2023 suggests xrays often show as normal in the actue stage of charcot despite the presence of visible swelling as they arent able to show the inflamation associated withthe pathology.
Going off the patients age and the location of the pain it could be calcaneal apophysitis.
**James et al 2013 ** describes Calcaneal apophysitis as a overuse injury as a result of increased impact traction by the achillioes tendon placed on the apophysis causing tiny avulsion fractures and inflamation at the site.
We know that calcaneal apophysitis affects adolescents and is associated with increased activity and sporty patients. Also we know that during that during that age the calcaneal growth outdoes muscle tendon growth which is where you end up with a shortoned tricep surae unit and increased traction of the aphosyial growth plate causing that repeated truama.
It cant be DMICS as that affects the dorsal capsular ligaments as a result of plantar fleixon of the forefoot on the rearfoot.
Cellulitus, Gout, Septic Arthritis, sickle cell crisis, It could be a calcaneal fracture.
What evidence based stratergies would you do to asses your patient to confirm diagnosis
Infared themomertry is one of the techniques used for daignosing and monitoring charcot as advocated by jones 2023 who states a temparature increase of 2 degress in the affected limb compared to the unaffected limb is indicative of charcot in the acute stage.
A mixture of plain radiograph and advanced imaging to assist in diagnosis and monitioring the disease. Roskopff (2019) says plain radiograph can be useful to asses the position of the bones and the progression of structural deformity through foot alignment measures like the mearys angle, cuboid height. And MRI imaging is more useful in early diagnosis and disease monitoring as it can show bone marrow odema, joint effusion soft tissue inflammation. Rosskopf specifically mentions some of the mri findings that can aid in differential diagnosis between charcot and osteomylitis. So the presence of of sinus tracts seen through mri are usually present in osteomylits and not in charcot. The ghost sign is another one so bones disappear in T1 scan with infection and reappear when contrast is added whereas with charcot the ghost sign is negative and bones look destroyed on all scans
Yamine 2011 showed that xrays frequentley missed ostoechondral fractures but they were picked up when mri was used so we can also use them for calc fracture.
Bone Scan - can also be useful as it shows up hotspots of metabolic activithy so inflammation in a charcot, helping to differentiate between cellulitus and charcot as no hotspot would show in the bone in cellulitus
What is Septic Arthiritis how does it present
Joint inflamattion secondary to infection most commonly bacteria
Acute joint pain, fever and swelling, warmth to the area.
How do we diagnose septic arthritis
Arthrocentisis would be requried where synovial fluid is drained from the suspected joint and sent for lab culture FINISH TOMORROW TALK ABOUT ELEVATIONS IN WBC
