What diagnosis should be considered for a diabetic patient with a swollen toe and an ulcer present?

In the context of a diabetic patient presenting with a swollen toe and an ulcer, Charcot neuroarthropathy should be considered as a diagnosis due to its association with peripheral neuropathy and alterations in weight-bearing pressures on the foot. Diabetes often leads to neuropathy, diminishing sensation in the feet, which may result in unnoticed injuries or trauma. This condition can progress to a destructive arthropathy that manifests as swelling, deformity, and ultimately ulcers due to compromised tissue integrity around the joint.

Patients with Charcot neuroarthropathy typically exhibit rapid swelling in the foot or ankle, warmth, and redness, often without significant pain, which can make it challenging to diagnose initially. Importantly, the presence of an ulceration is particularly relevant, as the combination of neuropathy and increased mechanical stress can lead to skin breakdown and ulcer formation.

While osteomyelitis can also be a consideration in a diabetic patient with a swollen toe and ulcer due to the risk of infections associated with diabetic foot ulcers, its clinical picture is often accompanied by systemic signs of infection, such as fever and severe localized pain—symptoms which are not as prominent in Charcot neuroarthropathy. Gout and psoriatic dactylitis generally present with different symptoms,