Clinical findings Clinical findings include erythema, edema and increased temperature in the affected joint. In<unk>  foot joints, plantar ulcers may be present. Note that it is often difficult to differentiate osteomyelitis from a Charcot joint, as they may have similar tagged WBC scan and MRI features (joint destruction, dislocation, edema). Definitive diagnosis may require bone or synovial biopsy. Radiologic findings First, it is important to recognize that two types of abnormality may be detected. One is termed atrophic, in which there is osteolysis of the distal metatarsals in the forefoot. The more common form of destruction is hypertrophic joint disease, characterized by acute peri-articular fracture and joint dislocation. According to Yochum and Rowe, the "6 D's" of hypertrophy are: # Distended joint # Density increase # Debris production # Dislocation # Disorganization # Destruction The natural history of the joint destruction process has a classification scheme of its own, offered by Eichenholtz decades ago: Stage 0: Clinically, there is joint edema, but radiographs are negative. Note that a bone scan may be positive before a radiograph is, making it a sensitive but not very specific modality. Stage 1: Osseous fragmentation with joint dislocation seen on radiograph ("acute Charcot"). Stage 2: Decreased local edema, with coalescence of fragments and absorption of fine bone debris. Stage 3: No local edema, with consolidation and remodeling (albeit deformed) of fracture fragments. The foot is now stable. Atrophic features: # "Licked candy stick" appearance, commonly seen at the distal aspect of the metatarsals # Diabetic osteolysis # Bone resorption
Neuropathic arthropathy
Osteomyelitis
Compression arthralgia
Jaccoud arthropathy
Glossitis
Crystal arthropathy
Enthesitis
Enteropathic arthropathy