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A 50-year-old man with type 2 diabetes mellitus for 13 years presented with painless swelling of the left foot over the previous 18 weeks. He had earlier received multiple courses of antibiotics without improvement. There was no history of trauma, foot ulceration, rheumatoid arthritis or inflammatory arthropathy. His HbA1c was 7.6%, erythrocyte sedimentation rate 19 mm/hour, white blood cell count 9600/mm3 and uric acid 4.3 mg/dL. Examination revealed a swollen, erythematous, deformed left foot with rocker bottom deformity and loss of longitudinal, transverse arch (figure 1A). He had distal symmetric sensorimotor polyneuropathy up to the …
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.