case_images: PMC4472877_01
case_images: Frontal view of the child
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case_images: F1
case_images: A 7-year-old female child visited the depart ment of pedia-tric medicine with a chief complaint of swelling in the left ankle since 2 weeks (Fig. 1).
case_images: Charcot's joint
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case_images: PMC4472877_01_ijcpd-08-075-g002.jpg
case_images: F2
case_images: The condition was diagnosed as osteomyelitis of the left ankle (Charcot's joint, osteoarthritic neuropathy) (Fig. 2) and treatment was initiated for the left ankle.
case_images: Degenerated nails on the digits of the hands
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case_images: PMC4472877_01_ijcpd-08-075-g003.jpg
case_images: F3
case_images: The physical examination disclosed that the patient had dry skin and wounds along with degenerated nails on many of the digits of the hands (Fig. 3).
case_images: Restricted mouth opening
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case_images: F4
case_images: The mouth opening was restricted (27 mm) (Fig. 4).
case_images: Dental caries in relation to 54 and 64
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case_images: PMC4472877_01_ijcpd-08-075-g005.jpg
case_images: F5
case_images: The lower arch was edentulous except for the permanent first molars and decay was observed on 54, 64, 36 and 46 (Fig. 5).
case_images: Elli's class I fracture in relation to 11 and 21
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case_images: PMC4472877_01_ijcpd-08-075-g006.jpg
case_images: F6
case_images: The maxillary incisors showed Ellis class I fracture (Fig. 6).
case_images: Dental caries involving the pulp in relation to 36
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case_images: F7
case_images: Also, severe bone loss and dental caries involving the pulp in relation to 36 was noticed (Fig. 7).
case_images: Lateral cephalogram revealing the absence of tooth buds and severe mandibular prognathism
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case_images: F8
case_images: A lateral cephalogram taken to evaluate the maxillo-mandibular relationship revealed the absence of tooth buds and severe mandibular prognathism (Fig. 8).
case_images: Magnetic resonance imaging revealed no obvious abnormality in the development and the condition of the brain
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case_images: F9
case_images: Magnetic resonance imaging was advised by the department of neurology and pediatrics to assess the development and condition of the brain (Fig. 9).
case_images: Radiographs of the feet revealed Charcot's joint
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case_images: F10
case_images: Radiographs of the feet revealed Charcot's joint (Fig. 10).
case_images: Triple antibiotic paste filled in the pulp chamber and permanent restoration done for 36
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case_images: F11
case_images: So triple antibiotic paste was filled in the pulp chamber and a permanent restoration was done (Fig. 11).
case_images: Composite restoration of maxillary central incisors
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case_images: PMC4472877_01_ijcpd-08-075-g012.jpg
case_images: F12
case_images: Composite restorations were done for the fractured maxillary incisors (Fig. 12).
case_images: A full thick excision skin biopsy and a nerve biopsy being performed
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case_images: PMC4472877_01_ijcpd-08-075-g013.jpg
case_images: F13
case_images: Simultaneously, a full thick excision skin biopsy and a nerve biopsy were also performed to assess the severity of the condition (Fig. 13).
case_images: Orthokeratotic squamous epithelium with papillomatosis
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case_images: F14
case_images: The skin biopsy revealed orthokeratotic squamous epithelium with papillomatosis (Fig. 14) and dermis showing adnexal structures which did not show any nerve fibres (Fig. 15).