"Silent" bone stress injuries in the feet of diabetic patients

NewsBot · Jan 12, 2007

Members do not see these Ads. Sign Up.
"Silent" bone stress injuries in the feet of diabetic patients with polyneuropathy: a report on 12 cases.
Chantelau E, Richter A, Ghassem-Zadeh N, Poll LW.
Arch Orthop Trauma Surg. 2007 Jan 11;

BACKGROUND: Bone stress injuries are rarely being diagnosed in patients with sensory neuropathy, most likely because they may be silent in terms of pain. Load-related pain is considered a key feature of any bone stress injury, a symptom, which may be partially or completely absent in subjects with sensory neuropathy (loss of protective sensation). We evaluated the clinical course of bone stress injuries in insensitive feet in diabetic patients with polyneuropathy.

METHODS: We investigated 12 consecutive diabetic patients with bone stress injuries of the foot (bone marrow edema, bone bruise and microtrabecular fractures, on magnetic resonance imaging MRI), which were undetectable on plain X-ray. All patients suffered from diabetic polyneuropathy, none of them had an active foot ulcer.

RESULTS: The patients presented with a swollen foot, which was only mildly painful and did not prevent them from walking. Complaints were related to the swelling, which increased during load-bearing. In seven cases, a traumatic event preceding the onset of symptoms could be ascertained. MRI disclosed stress injuries in 2.5 (1-8) [median (range)] bones per foot. In 11 patients, treatment was started immediately by off-loading with total contact cast for 17 (8-52) weeks, followed by gradual increase in weight bearing. One patient unfortunately received off-loading treatment only after deforming fractures had developed. All bone injuries healed uneventuelly in eight patients, and with residual mild osteoarthrosis in three patients without gross deformities. However, the untreated patient developed severe Charcot foot deformity.

CONCLUSIONS: In diabetic patients with polyneuropathy, symptoms of bone stress injuries of the foot are atypical, in that there is load-related swelling rather than load-related pain. Immediate diagnosis, and treatment with off-loading, leads to a restitutio ad integrum like in non-neuropathic patients. Delayed cessation of overuse, however, may cause irreversible joint and bone damage (Charcot foot).
Click to expand...

Admin2 · Jan 13, 2007

Related threads:
Pamidronate infusion timing in Charcot Rx
Charcot's - the perils of procrastination
Bone stress as trigger in Charcot's foot
Surgey in active Charcot
Charcot foot and Bone re-modelling
Charcot's: farewell to the neurotrophic theory.

NewsBot · Feb 14, 2023

Rate of tarsal and metatarsal bone mineral density change in adults with diabetes mellitus and peripheral neuropathy: a longitudinal study
Nicholas J. Youmans, Rachana S. Vaidya, Ling Chen, Hyo-Jung Jeong, Alexa York, Paul K. Commean, Mary K. Hastings & Jennifer A. Zellers
Journal of Foot and Ankle Research volume 16, Article number: 6 (2023)

Background
In people with diabetes (DM) and peripheral neuropathy (PN), loss of bone mineral density (BMD) in the tarsals and metatarsals contribute to foot complications; however, changes in BMD of the calcaneal bone is most commonly reported. This study reports rate of change in BMD of all the individual bones in the foot, in participants with DM and PN. Our aim was to investigate whether the rate of BMD change is similar across all the bones of the foot.

Methods
Participants with DM and PN (n = 60) were included in this longitudinal cohort study. Rate of BMD change of individual bones was monitored using computed tomography at baseline and 6 months, 18 months, and 3–4 years from baseline. Personal factors (age, sex, medication use, step count, sedentary time, and PN severity) were assessed. A random coefficient model estimated rate of change of BMD in all bones and Pearson correlation tested relationships between personal factor variables and rate of BMD change.

Results
Mean and calcaneal BMD decreased over the study period (p < 0.05). Individual tarsal and metatarsal bones present a range of rate of BMD change (-0.3 to -0.9%/year) but were not significantly different than calcaneal BMD change. Only age showed significant correlation with BMD and rate of BMD change.

Conclusion
The rate of BMD change did not significantly differ across different foot bones at the group level in people with DM and PN without foot deformity. Asymmetric BMD loss between individual bones of the foot and aging may be indicators of pathologic changes and require further investigation.
Click to expand...

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

Plantar pressures and bone mineral density

Cuboid bone spurs

Shape variations of hind and midfoot bones in flatfoot subjects

Calcaneal bone marrow lesions and plantar fasciitis

Radiographic scoring system for new bone formation in gout

Pathological and normal variability of foot bones in osteological collections

The cuboid bone

Share This Page