Imaging recommendation · Musculoskeletal

Diabetic foot deformity, suspected Charcot neuroarthropathy

Q: What's the alternative imaging for diabetic foot deformity, suspected charcot neuroarthropathy when distinguishing charcot from osteomyelitis?

NM — Indium-111 WBC + Tc-99m sulfur colloid scan (or PET/CT) (iv contrast).

Recommended: X-ray Foot + MRI Foot with and without contrast is the preferred imaging study for diabetic foot deformity, suspected charcot neuroarthropathy. Neuropathic destructive arthropathy.

Recommended study

X-ray Foot + MRI Foot with and without contrast

MRI IV contrast Preferred Musculoskeletal OutpatientAcute inpatient Reviewed 2026-05

Neuropathic destructive arthropathy. Distinguishing from osteomyelitis is the key clinical question.

If the default doesn't apply

Distinguishing Charcot from osteomyelitis

NM Indium-111 WBC + Tc-99m sulfur colloid scan (or PET/CT) IV contrast

Watch-outs

Charcot can coexist with osteomyelitis

Particularly in setting of ulcer — image carefully; bone marrow signal on MRI vs WBC scan helpful.

Acute Charcot is a non-infectious emergency

Total contact casting and immediate non-weight-bearing prevents progression to chronic deformity.

Pearls

5 D's of Charcot: Distended joints, Disorganization, Density (increased), Debris, Dislocation.
Eichenholtz stages: developmental, coalescent, reconstructive.
Midfoot Charcot causes 'rocker-bottom' deformity; high amputation risk if untreated.