Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2016; 4(7): 181-186
Published online Jul 16, 2016. doi: 10.12998/wjcc.v4.i7.181
Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature
Mehtap Evran, Murat Sert, Tamer Tetiker, Gamze Akkuş, Omer Sunkar Biçer
Mehtap Evran, Murat Sert, Tamer Tetiker, Gamze Akkuş, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, University of Cukurova in Adana, 01330 Adana, Turkey
Ömer Sunkar Biçer, Department of Orthopedics and Traumatology, Cukurova University Medical Faculty, University of Cukurova in Adana, 01330 Adana, Turkey
Author contributions: Evran M, Sert M and Tetiker T performed and designed the research, and followed and treated of the patients; Evran M and Akkuş G researched data; Bicer ÖS contributed that followed, debridement or operated of the patients; Evran M, Sert M and Tetiker T wrote the paper; all authors approval final paper.
Institutional review board statement: It was not obtained any approval from the Institutional Review Board. Because this study designed as the retrospective case report.
Informed consent statement: Informed consent form was taken from the patients.
Conflict-of-interest statement: The authors declared that there is no any competing interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mehtap Evran, MD, Assistant Professor, Endowed of Endocrinology, Department of Internal Medicine, Division of Endocrinology, Cukurova University Medical Faculty, University of Cukurova in Adana, Sarıçam, 01330 Adana, Turkey. mehtap.evran@hotmail.com
Telephone: +90-532-7818634 Fax: +90-322-3386879
Received: February 18, 2016
Peer-review started: February 19, 2016
First decision: March 25, 2016
Revised: April 5, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: July 16, 2016
Abstract

Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.

Keywords: Diabetes mellitus, Foot ulcer, Calcaneal fracture

Core tip: Spontaneous calcaneal fractures may occur without any trauma in diabetic patients, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. Despite all treatment applied, amputation below knee had to be performed in 2 patients. It must be remembered that spontaneous calcaneal fracture may develop in patients with diabetic foot ulcer and this condition may lead to amputation earlier.