Complications of foot and ankle surgery in patients with diabetes

Treatment of the foot and ankle in patients with diabetes often is fraught with complications, frequently multifactorial in nature. Because of the multidisciplinary approach to the patient with diabetes, it is imperative that the patient and all healthcare professionals who are treating the patient recognize the foot at risk, and the clinical hallmarks of Charcot neuroarthropathy. Failure to do so often leads to disastrous results, such as ulceration, destruction of normal foot architecture, and progressive deformity too severe to accommodate a brace, thereby necessitating surgical intervention. The surgical treatment of the foot in a patient with diabetes requires knowledge of the pathophysiology of the neuroarthropathic (Charcot) foot, so that the appropriate timing, extent of surgical intervention, and postoperative treatment in this unique population assures a higher success rate. One also must recognize associated factors that may be present in these patients, such as peripheral vascular compromise and poor nutritional status.