Abstract
Diabetic osteo-arthropathy with a high degree of peripheral nervous disturbance is not always rare. The authors report an interesting case who developed stress fractures of the bilateral calcaneus during kinesitherapy. The patient was a 27-year old female with insulin-dependent diabetes mellitus accompanied by remarkable dysfunction of the autonomic nervous system.
She had a rapid onset of diabetes mellitus and received insulin therapy for 12 years. She had obesity (severity of obesity; 26.5%), retinopathy (right; Scott IIIa left; Scott Vb) and neuropathy. She was admitted in a hypoglycemic coma because of poor control of blood sugar. She started gait exercises of 6 km per day after recovery from hypoglycemia, and developed avulsion stress fractures of the bilateral calcaneus in the course of approximately 3 weeks. Calcaneal pain was diminished by rest, use of plantar arch supports and loss of body weight. After one year and 5 months, X-ray photographs showed that the fractures had healed with some residual of deformity. The motor nerve conduction velocity was delayed, and remarkable dysfunctions of the vagus and sympathetic nervous systems were revealed in various autonomic nervous function tests. X-ray revealed slight osteoporosis, and analytical results by the MD method of hand X-ray showed the initial stage of osteopeny.
It was supposed that, based on her slight osteopeny and dysfunction of autonomic and motor nervous systems, the stress fractures of the calcaneus were induced by obesity and the sudden start of kinesitherapy, in spite of her comparatively young age.
