Management

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

Fig. 3.12 Fractured styloid process at base of 5th metatarsal.

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

Toe 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.

Calcaneal fractures

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.

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.

Charcot Crutches

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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