Charcot joint

I am 29 years old girl with no history of diabetes, suddenly had a severe pain and swelling in my right ankle with no redness in July 2009, Same day I also got fever which continued only for 4-5 days. X-ray was not done thinking that its an ankle sprain. Hot/cold water therapy was done for two months but there was no improvement. After that in Sep 2009 X-ray was done and it revealed that fracture is there, it was decided to get MRI and few blood tests done. ESR value was 65 and CRP was also positive i.e. 10.5. Based on MRI and blood test reports, it was diagnosed as bone TB. Six weeks plaster was put. For one year i.e. Oct 2009 to Oct 2010, anti TB drugs was taken. Again MRI and blood tests were done in Oct-2010, ESR value came down to 22 and CRP was also negative i.e. 0.6, and it was concluded that TB is cured. Swelling also got reduced but continued to persist along with moderate pain. After about two months i.e. in Jan 2011 again the same ankle got fractured while getting out of car, both the feet went in ditch. It had to be set in position through surgery by putting nails. After 6 weeks it became OK. In March 2011 an X-ray showed that the joint is further destroyed and apparently it looked TB is more acute. Then biopsies were taken for both tissues and bone and it showed no evidence of TB. Orthopedic surgeons say that it may be Charcot joint and they rule out any surgery, as they feel the joint will fail again, and advise me to put ankle brace. I had been referred to Neurologist. nerve conduction velocity (NCV) test was normal. Blood sugar level was also normal (Fasting 83 and PP 92, HbA1c 4.80). Vitamin B12 test level was 482. MRI of spine was also normal. And neurosurgeon ruled out the joint as Charcot joint. Ankle joint movement is also present. Now I am interested  in getting my pain releived. Again Consulted with my orthopedic surgeon and subtalar fusion or triple fusion along with bone grafting have been offered but with caution, as they still feel that it might be charcot joint . Can it be charcot joint when my NCV report is normal and there is no motor neuropathy? And can surgery be done? Pls advice.

[Dr Prasad, MBBS]

Hi,thanks for query. Your case is unfortunate and complicated. It is better that you please see arthroscope surgeon.Possibility of char-cot joint can not be completely ruled out. The reason for destruction of joint needs to be looked for then only some reasonable cure can be offered. Please be careful and wear ankle brace regularly. Please remain in contact with your doctor. In case the instability persists then surgery is the only answer.
Wishing you good health.