Muscle atrophy and muscle edema significantly more severe in diabetic patients with Charcot foot disease

Martin C. Berli et al conducted a study to evaluate the distribution and severity of muscle atrophy in diabetic patients with active Charcot foot (CF) compared to diabetic patients without CF. Furthermore, to correlate the muscle atrophy with severity of CF disease. The article has been published in ‘Skeletal Radiology’ journal.

The diagnosis “newly diagnosed active Charcot foot” was established by an interdisciplinary team of orthopedic surgeons, neurologists, and radiologists in all cases. The Charcot foot was declared as “active” when swelling, redness, and hyperthermia were present. The maximum time between MR examination and Charcot diagnosis was 4 weeks.

In this retrospective study, MR images of 35 diabetic patients (21 male, median:62.1 years ± 9.9SD) with active CF were compared with an age- and gender-matched control group of diabetic patients without CF. Two readers evaluated fatty muscle infiltration (Goutallier-classification) in the mid- and hindfoot. Furthermore, muscle trophic (cross sectional muscle area (CSA)), intramuscular edema (none/mild versus moderate/severe), and the severity of CF disease (Balgrist Score) were assessed.

Key findings of the study were:

• Interreader correlation for fatty infltration was substantial to almost perfect (kappa-values:0.73–1.0).

• Frequency of fatty muscle infltration was high in both groups (CF:97.1–100%; control:77.1–91.4%), but severe infiltration was significantly more frequent in CF patients (p-values: < 0.001–0.043).

• Muscle edema was also frequently seen in both groups, but significantly more often in the CF group (p-values: < 0.001–0.003).

• CSAs of hindfoot muscles were significantly smaller in the CF group. For the flexor digitorum brevis muscle, a cutoff value of 139 mm2 (sensitivity:62.9%; specifcity:82.9%) in the hindfoot was found to differentiate between CF disease and the control group.

• No correlation was seen between fatty muscle infiltration and the Balgrist Score.

The authors concluded - “Muscle atrophy and muscle edema are significantly more severe in diabetic patients with CF disease. Muscle atrophy does not correlate with the severity of active CF disease. A CSA < 139 mm2 of the flexor digitorum brevis muscle in the hindfoot may indicate CF disease.” 

For details of steps please refer to:

Muscle atrophy in diabetic patients with Charcot foot: a case control study

Martin C. Berli, Nicolas Azaiez et al

Skeletal Radiology (2023) 52:1661–1668

https://doi.org/10.1007/s00256-023-04328-1