PAINLESS STRESS-FRACTURES IN DIABETIC NEUROPATHIC FEET

We describe two patients with diabetes mellitus and associated neuropa thy, who presented with painless foot swelling and no history of traum a. X-Rays revealed recent underlying fractures - in one of a metatarsu s, and the other of a proximal phalanx. These were assumed to be (stre ss' fractures unassociated with pain because of the severe sensory neu ropathy. Though spontaneous fractures in neuropathic feet have been pr eviously described, they almost always occur in association with Charc ot joints, and are usually painful. The differential diagnosis of acut e swelling in the foot of a diabetic patient with sensory neuropathy s hould include stress fracture.