From the Guidelines
The next step for a 52-year-old diabetic female with a small avulsion fracture in the distal lateral calcaneus is simple immobilization, as the fracture fragments are small and nonarticular.
Treatment Considerations
- The patient's well-controlled diabetes is a positive factor, but it's essential to monitor her condition closely to prevent any complications.
- Immobilization is recommended for small, nonarticular, or minimally displaced fractures, as stated in the American College of Foot and Ankle Surgeons' guidelines 1.
- Additional treatment options may include:
- Open-backed shoes to reduce pressure on the affected area
- Heel lifts or orthoses to support the foot
- NSAIDs for pain management
- Decreased activity to avoid exacerbating the injury
- Stretching exercises to promote healing and prevent stiffness
- Weight loss, if indicated, to reduce stress on the foot and ankle
Important Considerations
- Local injections of corticosteroids are not recommended, as they may interfere with the healing process 1.
- If the patient shows improvement within six to eight weeks, the treatment plan can be continued until symptoms resolve 1.
From the Research
Diagnosis and Treatment
The patient's diagnosis of a small avulsion fracture in the distal lateral calcaneus, along with well-controlled diabetes, requires careful consideration of treatment options.
- The fracture type and location, as well as the patient's diabetic condition, are crucial factors in determining the best course of treatment 2, 3, 4.
- Studies have shown that diabetic patients are more prone to calcaneal fractures and may require early diagnosis and treatment to prevent significant bony deformity 4.
- The use of double row anchor fixation and excision of the fracture fragments has been described as a novel operative approach for calcaneal insufficiency avulsion fractures in diabetic patients 2.
Treatment Options
- Conservative treatment may be recommended in most cases, but surgical intervention may be necessary to treat large avulsed fragments or malunions 5.
- Rigid fixation is recommended for ankle fractures in patients with complicated diabetes to prevent Charcot neuroarthropathy and other complications 6.
- Early protected weight bearing can be allowed, provided rigid fixation without deformity has been achieved 6.
Complications and Outcomes
- Diabetic calcaneal fractures are severe and complex injuries that warrant careful evaluation to carry out adequate conservative or surgical management 3.
- The complication rates associated with diabetic fracture management are increased and may include poor wound healing, deep infection, malunion, and Charcot neuroarthropathy 3, 6.
- Hindfoot arthrodesis can salvage the limb in approximately 80% of patients with complicated diabetes and ankle fractures 6.