Nonoperative Management of Multiple Displaced Metatarsal Fractures in a Diabetic Neuropathic Patient.

Abstract

The management of fractures in diabetic patients poses unique challenges, particularly due to complications such as neuropathy, poor bone quality, and impaired healing. This case study explores the nonoperative management of multiple displaced metatarsal fractures in a 61-year-old male with type 2 diabetes and neuropathy. The patient presented with swelling and minimal pain in the right foot without a clear history of acute injury. Despite radiographic evidence of displaced fractures, the patient opted for conservative treatment due to high surgical risks, including comorbidities and concerns about compliance with postoperative care. He was treated with a controlled ankle motion walker and partial weightbearing for 4 months, ultimately achieving healing at all fracture sites except for a malunion in the second metatarsal. Over 28 months, the patient-maintained functionality with diabetic shoes and custom inserts, despite developing a mild metatarsus adductus deformity and evidence of osteoarthritis. This case highlights the potential for conservative treatment of complex metatarsal fractures in diabetic neuropathic patients, emphasizing the importance of individualized management plans and consideration of the patient's overall health status and preferences. As the prevalence of diabetes rises, this approach could serve as a viable option for similar cases, minimizing the risks associated with surgical intervention.