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Background
Charcot neuroarthropathy (CN) is a musculoskeletal condition that leads to a chronic progressive and destructive arthropathy. The most frequently involved joints are the tarsus and tarsometatarsal joints followed by the metatarsophalangeal joints and the ankle. Early offloading is recommended as it can prevent the further destruction of the joint. Peripheral neuropathy due to diabetes is the most common cause of Charcot foot. However, alcohol-induced neuropathy causing Charcot deformity is not a commonly seen condition. Our aim, with these two case reports is to raise the awareness that Charcot foot must be considered in any patient with alcohol abuse who presents with warm, swollen, erythematous foot, particularly in the context of peripheral neuropathy.
Case presentation (TABLE 1)
First case
A 67-year-old man with hypertension, hyperlipidaemia and a history of gastrointestinal bleeding and chronic alcohol abuse (28-32 units of alcohol per week) was referred to the orthopaedics department by his general practitioner due to spontaneous midfoot collapse. He had an x-ray that showed Lisfranc dislocations on both his feet. His problems with his feet started 12 months ago, when he was having difficulty in walking and when he walked his feet were turning inwards. He did not have any pain in his feet or any breaks in the skin, redness or swelling in the past. When the orthopaedic surgeon examined him there were deformities of both his feet and a definite prominence on the dorsum of the feet with loss of plantar arch. The patient noticed that he had a reduction in the plantar arch 1 month before seeing the surgeon. An oral glucose tolerance test (OGTT) was performed to rule out diabetes, and vitamin B12 levels were normal. Nerve conduction studies showed generalised symmetrical sensory motor neuropathy of axonal type. He had an MRI scan of his feet which showed extensive bony reactive changes and oedema in the tarsal and metatarsal region in both the feet and especially in the right foot. He had an isotope bone scan which showed symmetrical isotope uptake, involving the metatarsophalangeal and the proximal interphalangeal joints and the tarsal bones on the feet ( figure 1 ). These findings were consistent with CN, so he was referred to our foot clinic. When we examined the patient, he had...