Prosthetic technics in the aftercare of diabetic gangrene

This paper describes an appliance, modified from the original design of Charlesworth, which in our hands has found particular application to problems which have arisen from the conservative management of infection or gangrene in the feet of diabetic patients. These are complications of an aging population which has suffered peculiar nervous and vascular damage ofttimes for years before any typical symptoms or signs of trouble develop.

In recent years the introduction of antibiotic drugs has provided a choice of potent weapons to combat infections which previously were impossible to control except by drastic and radical surgery. In consequence conservative surgical procedures may now be undertaken which, without the help of these drugs, would still be unthinkable. It is important to realize that the treatment of the traumatic injuries of youth or early adult life differs sharply from that of the elderly diabetic. In the young adult loss of a leg below the knee can be almost completely compensated by the fitting of an adequate artificial limb, but in our experience very few patients over the age of sixty years will tolerate an artificial leg satisfactorily. This being so, a crutch is an inadequate and precarious substitute for a human limb. One fall from inexperience and the patient, losing confidence, prefers to spend the rest of his life in a wheel chair.