ArticleSurgery in practice and science2026
Asymptomatic Charcot foot in longstanding diabetes.
Article in Surgery in practice and science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Charcot neuropathic osteoarthropathy complicates an estimated 0.1-7.5% of diabetic patients in general clinic populations, yet misdiagnosis rates remain high - partly because the foot is often warm, swollen, and painless rather than obviously deformed. Undiagnosed cases range from 0.4% to 13% in published series. Aim: To detect preclinical Charcot disease by plain X-ray in longstanding diabetic patients attending routine follow-up, before clinical deformity develops. Methods: Cross-sectional prevalence/screening study, with structured short-term follow-up restricted to X-ray-positive patients, of 60 consecutive adults with type 2 diabetes mellitus (DM) of >10 years duration, seen at Al-Ramadi Teaching Hospitals between September 2023 and March 2024. All underwent bilateral foot X-ray in antero-posterior and oblique views, full clinical and neurological assessment, and laboratory investigations including HbA1c. Results: Thirty-one patients (51.7%) had X-ray changes fulfilling a pre-specified Charcot pattern - predominantly focal bone demineralization, subchondral fragmentation, and debris formation at articular margins. X-ray positivity correlated significantly with older age ( Conclusion: Over half of longstanding diabetic patients attending routine follow-up had X-ray changes fulfilling a Charcot pattern, though most were not MRI-confirmed. These findings support further investigation, with MRI-validated confirmation in a larger sample, before systematic plain bilateral foot X-ray screening can be recommended in this population; glycemic optimization and patient education on trauma avoidance remain appropriate in the meantime.
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