A 62-year-old woman with type 2 diabetes of 18 years' duration underwent a right below-knee amputation after developing a deep infection of her neuropathic foot. She lived abroad and had no rehabilitation, but 4 months later she was visiting her daughter in the UK, developed neuropathic ulceration of the left hallux and was referred to the diabetic foot clinic as an emergency.
At her second visit she mentioned that she had fallen and injured her stump when transferring from a taxi to her wheelchair. She was wearing a silicone sock on her stump at the time. She felt no pain in her stump after the fall, but 3 days later she developed severe pain in the stump which kept her awake at night and was described as 'aching' and 'spasmodic'. On examination there was minimal swelling, no haematoma and no break in the skin of the stump. X-ray revealed a fracture through the tibia extending to the resected surface (Fig. 7.4). She was referred to the fracture clinic and a bivalved stump splint was applied.
• In a neuropathic stump, signs and symptoms of fracture may be minimal or delayed
• Neuropathic stumps should be X-rayed following trauma.
Fig. 7.5 Callus on a stump.
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.