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The 21st Meeting of the Diabetic Foot Study Group 2026
24-26 September, 2026 | Florence, Italy
EP30
Charcot Knee in Diabetes: Imaging Features and Diagnostic Challenges in a Rare but Serious Complication
Poster Presenter
Authors
Anara Karaca, M Bates, W Tang, E Vainieri, C Manu, Da Elias, V Kavarthapu, ME Edmonds, N Petrova
Affiliations
Mike Edmonds Foot Unit, King'S College Hospital NHS Foundation Trust, London, United Kingdom, Department of Radiology, King'S College Hospital NHS Foundation Trust, London, United Kingdom, Department of Orthopaedics, King'S College Hospital NHS Foundation Trust, London, United Kingdom
Part of Topic
Charcot foot
Background and aims
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Charcot osteoarthropathy of the knee is a rare but serious complication of diabetic neuropathy.Delayed diagnosis may result in joint destruction and major surgical intervention. This studydescribes clinical presentation and imaging characteristics of suspected Charcot knee, emphasisingthe role of advanced imaging in early diagnosis.
Methods
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We performed a retrospective review of medical records and imaging studies of six people withdiabetes presenting with knee swelling and pain who were subsequently diagnosed with Charcotknee. Clinical context, radiographic findings, magnetic resonance imaging (MRI) features andmanagement strategies were analysed.
Results
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Nine Charcot knee presentations were identified in four men and two women (mean age 54±9 years).
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Knee symptoms developed during ipsilateral offloading for an active Charcot foot using a totalcontact cast in two cases (case study 1) and following Charcot foot reconstruction in one case (casestudy 2).
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In the remaining three individuals, all with type 1 diabetes, symptom onset was unrelated to traumaor active offloading. These patients had bilateral inactive Charcot feet and subsequently developedbilateral Charcot knees at intervals of three months, six months (Case study 3) and fifteen years.
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Initial plain radiographs were normal in most cases, with occasional findings of linear sclerosis (1) orjoint space narrowing (1).
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In contrast, MRI demonstrated bone marrow oedema in all knees, fractures in eight, joint effusion insix and ligament injury in three.
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Management included total contact casting with knee bracing in all cases, with additional wheelchairor crutches support where required. One individual required total knee arthroplasty due toprogressive joint destruction.
Conclusion
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Charcot knee can occur in people with existing/active or previous/inactive Charcot foot disease, evenwithout trauma or abnormal initial radiographs. New-onset knee swelling and pain in this populationshould prompt urgent MRI assessment. Early diagnosis and appropriate offloading may limitprogression, preserve joint integrity and reduce the need for surgery.