The Impact of Diabetic Peripheral Neuropathy on Bone and Joint Disease in Patients: Modern Treatment Options

Diabetes increases the risk of fracture, delays wound and bone healing, and at the most severe spectrum may lead to Charcot neuroarthropathy characterised by a progressive collapse of bone and joint structures. The presence of peripheral neuropathy, in particular measurable reduced sensation, is a defining aspect of the condition. The clinical presentation of patients with fractures and diabetes, and patients with Charcot neuroarthropathy will be discussed. Patients may present with an acute limb threatening condition or with the sequelae of advanced chronic deformity. Assessment and treatment pathways have been developed, requiring a multidisciplinary approach - involving the diabetologist, podiatrist, radiologist, microbiologist, orthotist, vascular, plastic and orthopaedic surgeon. Surgical treatment of Charcot deformity is regularly performed at our unit, a tertiary referral centre for this condition. Deformity reconstruction using one- or two-stage surgery is performed using anatomic reconstruction and long segment fixation, followed by a period of protection in a non load-bearing cast. Every patient with advanced peripheral neuropathy is at high risk of amputation. Limb salvage in our series of more than 100 patients is at 85 – 95%, mainly depending on pre-existing vascular disease. The role of peripheral neuropathy on bone maintenance, fracture and bone healing, and ability to load-bear is ill understood and requires close working relations of scientists and clinicians - but has direct consequences for prevention and treatment.