ABSTRACT
CONTENTS I. Introduction ................................................................................................................... 179 II. Wound Healing in the Diabetic Patient.......................................................................... 179 III. Fracture Susceptibility in the Diabetic Patient ............................................................... 180 IV. Undisplaced Fractures.................................................................................................... 180 V. Displaced or Unstable Fractures .................................................................................... 182 VI. Charcot Foot .................................................................................................................. 185 VII. Fractures of the Calcaneus ............................................................................................. 185 VIII. Fractures of the Hindfoot............................................................................................... 185 IX. Fractures of the Midfoot (Tarsometatarsal) ................................................................... 188 X. Fractures of the Forefoot ............................................................................................... 188 XI. Summary ........................................................................................................................ 190
References .................................................................................................................................. 191
I. INTRODUCTION
The U.S. Centers for Disease Control and Prevention estimates that there are more than 16 million Americans afflicted with diabetes. These individuals consume more than $44 billion in direct medical costs. Death rates from heart disease and the risk of stroke are two to four times that of adults without diabetes. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness yearly. Diabetes accounts for 40% of new cases of renal failure and multiple other organ system morbidities [1]. There are greater than 50,000 lower-extremity amputations yearly in the U.S. alone, with 85% being preceded by foot ulcers or foot infections [2,3]. A simple, undisplaced fracture in the foot or ankle of a diabetic patient may be the first step in the downward spiral leading to foot deformity, tissue breakdown, infection, and eventual lower-extremity amputation and premature death. When one considers the impact that foot and ankle fracture imparts to the diabetic population, one must appreciate diabetes as a complex metabolic disease that affects the woundhealing process, the peripheral vascular and nervous systems, and virtually every organ system in the body.
