People with diabetes have a high prevalence of orthopaedic problems and experience an increased risk of adverse outcomes following orthopaedic interventions. Diabetes can cause numerous problems, ranging from nerve damage to arterial disease to obesity to infections at the site of a surgical procedure. This is only increased when a person with diabetes struggles with obesity, which is common but not universal among diabetic patients.
The reason diabetes causes certain conditions can be attributed to poor glycemic control, neuropathy, and end-stage renal disease, which can lead to multiple issues. Fortunately, people with diabetes can take preventative actions, while noting the multiple diseases that result from diabetes, and gain a better handle on their outcomes.
Charcot Joint and Foot
Nerve damage caused by diabetes can lead to degenerative joints. This largely occurs in the foot, also known as Charcot foot.
The main symptom of Charcot foot is a loss of sensation, which can lead to multiple problems for people with diabetes. The loss of sensation lowers the likelihood of feeling and/or discovering an injury, such as a cut. These cuts can lead to infections if not discovered. In addition, the foot may also become red and swollen, unstable, or deformed, which may not feel painful due to the loss of sensation.
Fortunately, the progression of Charcot joint or foot can be slowed. Washing feet on a daily basis to monitor cuts and injuries is a great way to prevent infection. In addition, limiting weight-bearing activities can help slow progression.
Osteoporosis
Osteoporosis causes bones to weaken, leaving them more susceptible to fractures. People with diabetes have a higher occurrence of osteoporosis than most people.
The best way to prevent the progression of osteoporosis, along other problems associated with the disease, is living a healthy, active lifestyle. A healthy diet will improve bone health and overall health while remaining active will maintain bone density and keep the muscles surrounding bones and joint healthy and strong; this helps to take the pressure off osteoporosis-stricken bones.
Osteoarthritis
Similar to how osteoporosis breaks down bones, osteoarthritis breaks down the cartilage in between the joints. This is more common in people with type 2 two diabetes, as both type 2 diabetes and osteoarthritis are associated with obesity. Common side effects include joint pain, swelling, stiffness, and a loss of mobility in the joint.
Just like osteoporosis, the most effective ways to prevent osteoarthritis and the pain associated with it is by living a healthy and active lifestyle. A healthy lifestyle will lead to weight loss and an increase in muscle strength around the joints, which will take additional pressure off the arthritis-stricken areas.
D.I.S.H.
Also known as Forestier disease, Diffuse Idiopathic Skeletal Hyperostosis (DISH) occurs when tendons and ligaments harden, most commonly around the spine. People with Type 2 Diabetes are more susceptible to DISH. To offer a brief description of the disease, the insulin hardens tendons and ligaments until they essentially turn to bone, which must be removed.
DISH is commonly treated with pain relievers to ease one’s pain during daily life. If necessary, surgery will be conducted to remove the newly-formed bones.
Dupuytren’s contracture
People with diabetes are at an increased risk of developing Dupuytren’s disease—a condition that a affects the muscle fascia underneath the skin. Over time, the fascia thickens, which tightens the skin and results in the finger being pulled inward in a bent position toward the palm, impairing hand function. Dupuytren’s disease may look like lumps, cords, and nodules of tissue lying under the palm.
This disease progresses slowly, over a period of years. Fortunately, there are both surgical and non-surgical options for people who experience this disease. Surgeons can simply remove the cords, which will temporarily improve hand function until the cords return.
There have been recent developments for treating Dupuytren’s disease. Enzyme injection involves injecting the enzyme directly into the cords, which will weaken and dissolve the cord for 24 to 72 hours. The surgeon will then administer local anesthesia and manipulate the fingers in a manner that breaks apart the restrictive cords. This typically results in less pain and swelling than surgery.
A Needle Aponeurotomy is also a new option for people with Dupuytren’s Disease. During this operation, the surgeon will apply local anesthesia to the hand. They will then insert a hypodermic needle and break apart the restrictive cords.