Management of neuropathic fractures in the foot and ankle

Neuroarthropathy, a rapid, painless destructive process, has become increasingly prevalent among long-lived diabetic patients. It is characterized by warm, swollen joints with a grossly disorganized radiographic appearance, in spite of which the patient is often pain-free. Neglect of this condition results in progressive deformity or instability, often complicated by ulceration and infection, which can ultimately result in loss of independent mobility, loss of the affected limb, and even death. In most cases, a plantigrade, stable, and functional foot can be achieved with simple nonoperative techniques, such as the use of a total-contact cast or shoe modification. A few patients in whom uncontrolled instability or major osseous prominences cause recurrent ulceration will require reconstructive surgery (either exostectomy or osteotomy/arthrodesis). Although some patients will have an improvement in function, ongoing vigilance is necessary.