ORGANIZED CHAOS - COMPUTED TOMOGRAPHIC EVALUATION OF THE NEUROPATHIC DIABETIC FOOT

Accurate radiographic evaluation of diabetic neuroarthropathy is incre asingly difficult as the disease becomes more florid. 22 patients with a known diabetic neuroarthropathy of one or both feet were prospectiv ely examined by computed tomography (CT) in the axial and coronal plan es. Bilateral changes of a neuroarthropathy were present in 75% of cas es. Distinct patterns of disease were seen and categorized into five t ypes in order of increasing severity. Changes at the medial tarsometat arsal joints and adjacent intercuneiform joints were seen in all affec ted feet. More extensive disease involved the medial arch more commonl y than the lateral. Fractures of the tarsal bones were found in 32% of cases and were associated with neuroarthropathic changes in adjacent joints. Calcaneal fractures were seen in four feet. A Lisfranc fractur e-dislocation was present in 41% of cases and a bilateral in only 21%. A single CT examination of the foot, while an accurate method of demo nstrating the extent of the disease, is an insensitive indicator of di sease activity.