Diabetic hindfoot problems

Diabetes prevalence is reaching pandemic proportions in the 21st century. Since the discovery of insulin physicians and surgeons have been challenged by the long term complications of diabetes. Foot and ankle complications consume a great proportion of healthcare resources. In recent times there have been great advances in understanding the basic science behind the aetiology of diabetic foot and ankle complications. The combination of abnormal biomechanics, neuropathy and vascularity is integral to the pathogenesis of ulceration and Charcot arthropathy. The article discusses the unique biomechanical properties of a diabetic neuropathic lower limb.Hindfoot and ankle ulcerations have a greater association with major lower limb amputation. Conservative treatment includes prescription of off-loading orthotics and local ulcer treatment. However heel ulcers can also be the result of overzealous surgical intervention.Mirroring the increased prevalence of diabetes, Charcot arthropathy incidence is rising. We discuss the conservative and surgical management of this devastating complication of a neuropathic hindfoot and ankle. Conservative management is the mainstay of the initial phase of this disease though evidence is appearing of the benefits of early surgical intervention. Surgical interventions aim at preserving the lower limb and producing a stable plantigrade foot.