Podiatrist | Foot & Ankle Surgery Questions bone growth

I have pain in my ankle and it may need surgery. Will my diabetes make it difficult to heal my ankle?

I am having a lot of pain in my ankle and my doctor has suggested that it will need to be operated on because there's a bone growth. I am also diabetic. Will my diabetes make it hard for my ankle to heal?

15 Answers

Diabetes can make healing difficult. So, prior to surgery, your blood glucose and your Hemoglobin A1C have to be well controlled. Your circulation is another factor that has to be taken into consideration. Great circulation = fast/great healing. Poor circulation = poor healing. So, because diabetes can affect circulation, it is usually a factor we surgeons consider, though the circulation is the ultimate determination of the healing time and quality.
It depends on how well you diabetes is controlled and the quality of the blood supply to the area and the existence of other medical conditions. You would need to discuss this with your doctor to determine if there are other risks. Just having diabetes doesn’t necessarily result in delayed healing
Diabetes can sometimes affect healing. If your diabetes is well-controlled, you have good circulation, and you have a good diet, then most of the time it will not be a major issue.

Jonathan M. Kletz, DPM
Optimizing a patient's health before any type of surgery, particularly elective surgery is absolutely critical. With regards to musculoskeletal surgery, there are comorbid conditions that may influence the outcome and any acute complications that may occur. Glycemic or blood sugar control is absolutely critical from the standpoint of wound healing, reduction of
secondary infection risk, and bone healing. Elevated blood sugars impact healing at the cellular level and influence compromised immune response. Blood sugars can be monitored acutely with finger sticks and getting a snapshot understanding of current control, but more frequently, we utilized a test known as the hemoglobin A1c to get a better understanding of her overall glycemic control over an extended period of time. Although there is no consensus, we do appreciate that a hemoglobin A1c representing normal glycemic control is ideal. In my own practice, I typically utilize an A1c of 7.5 mg/dL as a cutoff point for elective surgery. As a side other factors that are looked at particularly when it comes to bone and joint
surgery include the health of the bone from the standpoint of vitamin D as well as social factors such as smoking, which can also impact wound healing and bone healing.

As long as your HbA1c is <8 (<7 better) and your circulation is good, you should be fine.
Unfortunately, your diabetes is a real problem and potentiates a lot of post-op problems. Since your problem is not emergent, I would want your sugar under control and your Hemoglobin A1c as low as possible. Your chance of infection is also increased and I would prefer you stay in the hospital long enough to give you IV prophylactic antibiotics. If you smoke, I would not do this surgery until you have quit smoking for a month. Type 2 diabetics tend to have an elevated BMI. If you do, I would ask you to diet. Again, these factors increase your infection possibility. And post-op, diabetics heal slower if your blood sugar is elevated.

Rod Tomczak, MD, EdD
Generally speaking, diabetes does slow down healing. With that being said, you will generally go through a pre-op workup prior to surgery to determine if your glycemic control is adequate for surgery or not. If your A1C levels are below a certain threshold, your recovery would likely not be impacted very much.
If your blood sugar is under control you should not have a problem with healing
Diabetes will complicate any surgery. This does not mean that the surgery cannot be done. Work with your surgeon, primary care provider and endocrinologist to optimize your glucose control prior to surgery. After surgery be sure to understand and follow your surgeon’s post operative instructions. If you are unsure of what to do don’t be afraid to ask for clarification. Good luck.
Diabetes alone is not a reason to avoid surgery. HOWEVER, there are more potential complications healing in a patient that is diabetic. The biggest concerns about healing in a diabetic are 1) Circulation must be adequate for good healing (this can be tested) 2) A diabetic automatically has a decreased immune response and is more susceptible to infection (your physician must be one familiar with treating and doing surgery on diabetic patients, and must do diligent work up prior to, and good follow up after surgery). Your blood glucose must be under very good control (Hemoglobin A1c <7.0).
If your diabetes is uncontrolled, then you are at risk during healing at the surgical incision site, but you can get minimal invasive surgery like arthroscopic surgery to remove a spur, which can reduce your infection rate. Please visit a foot and ankle surgeon near your home.
Diabetes raises your risks for any surgery, so I'd discuss the details with your surgeon, as to what you can do to maximize your healing.
It may not make it hard but it may make it longer. Sometimes with diabetes it takes longer to heal.
If you diabetes is well controlled, you should have no problem healing from your surgery. A blood test called a hemoglobin a1c (Hgb a1c) can be performed by your primary care physician or whoever is treating your diabetes to get an idea of your blood sugar control. Ideally, this number should be between 6 and 7 but your surgeon will decide what level is acceptable for the surgery
Yes & no. Now that's a worthless answer, but it is true. If your diabetes is well-controlled, then the healing process should be no different than if you did not have diabetes, so the answer would be no. Your ankle should heal as if you did not have diabetes. If your blood sugar is NOT well-controlled, the answer is different. Poorly controlled diabetes (high blood sugars & an elevated HbA1c) will impair healing & may allow wound infection & poor healing. So, get your blood sugar under control and your HbA1c below 7% (ideally below 6.5%) before surgery to get the best result. Also, get a consult with a diabetes specialist to assist your surgeon & you in the post-op management to get the optimum results. It can be done with good results, but it takes some work on the part of the medical-surgical team and YOU.
I hope for you a good result.