Differentials: Osteomyelitis vs Charcot Neuroarthropathy Foot

Charcot neuroarthropathic (CN) foot and Diabetic foot Osteomyelitis (DFO) are two differential complications that occur due to diabetes. CN and DFO are notoriously  troublesome to differentiate at initial presentation. Therefore, podiatrists that are presented with a diabetic foot patient suspected of OM or CN, must be extremely vigilant in diagnosing these entities as treatment vastly differs– a wrong treatment can cost someone their limb, and their lives.


Submitted: March 2016

Authors: Rossi Bad

Title: A summary of the differences between Charcot Foot and Osteomyelitis.


Charcot Neuroarthropathic Foot Osteomyelitis (Acute)
Neuropathic/Biomechanical etiology Infective etiology
Elevated leg may reduce erythema Will not affect the localized erythema
Associated with long standing diabetic, and Leprosy History of diabetic foot ulcers, open fracture, and deep wounds (probe to bone)
MRI shows diffused bone edema particularly in multiple joints, and articular surfaces i.e. peri-articular and subchondral edema MRI would show localized bone edema
FDG PET is diffused and <2 i.e. lesser glucose uptake FDG is localized and >3 i.e greater glucose uptake
Affects midfoot Affects toes and forefoot
May appear grossly as a “deformed” foot. i.e. rockerbottom foot Foot shape may be normal
Pulses may be bounding Pulses may be normal to non-existent
ESR non-elevated ( in NON-ACUTE stage) ESR elevated ( 70 mm/hr)
Radiograph will show non-specific  changes: periosteal reaction, joint dislocation, fractures Radiograph will show focalized cortical destruction with involucrum, sequestrum, clocoae,
Bone biopsy to rule out osteomyelitis Bone biopsy is the gold standard, and can guide treatment plan





  1. http://diabeticfootandankle.net/index.php/dfa/article/download/21855/pdf_1
  2. http://www.podiatrytoday.com/osteomyelitis-keys-diagnosis-and-treatment