A 62-year-old man with type 2 diabetes for 15 years presents with history of erythematous, hot, swollen right foot for 2 weeks (Figure 212-1). He is on multiple medications for management of his diabetes, but it is not successfully controlled. The patient does not recall any trauma to the foot. Three days ago, he noticed pain in his foot. He denies fever or chills. The radiograph of his foot (Figure 212-2) shows midfoot osteopenia, an early sign of acute Charcot arthropathy.