All neuropathic fractures should be treated promptly in conjunction with orthopaedic surgeons. Fractures that develop Charcot changes are associated with the greatest overall delay in diagnosis and management. Fractures should be treated with non-weightbearing and plaster
immobilization, supported by crutches and/or wheelchair. Fractures do not heal at the same rate as in non-diabetic patients and plaster casts should therefore be continued until healing is confirmed by X-ray.
In our experience, fractures in stage 2 and higher stage diabetic feet take two or three times as long to heal as they do in low-risk or normal feet. Many health-care professionals appear to be unaware of this.
Many neuropathic patients have osteopenic bones and are prone to fracture bones after minimal trauma. Because of the lack of symptoms, fractures are frequently only detected after a routine X-ray.
Treatment of specific fractures
The toe is strapped to its neighbour for a splinting effect. Metatarsal fractures
The patient is put into a below-knee plaster cast until X-rays confirm healing, which may take up to 6 months. In some cases full union is not attained. However, at this stage the initial swelling has usually resolved and patients are mobilized slowly out of the cast.
The limb should be immobilized in a below-knee plaster cast until radiological healing has occurred.
Fig. 3.13 (a) Fractured base of first metatarsal, (b) The development of a Charcot foot with disorganization of the tarsus and fragmented navicular and cuboid.
Tibial and fibular fractures
These fractures can be treated either by open reduction and internal fixation or by cast immobilization.
• We give very precise advice regarding timing of rehabilitation process and dangers of trying to speed the process.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...