I brought Mother home from the hospital last night. She has diabetes and she broke her ankle requiring surgery. The nurses gave us a long list of Dos and Don'ts. They were very firm in telling us we had to follow the instructions exactly. My sister and I have been taking care of Mother all our lives. What is all the fuss about?

It's wonderful that your mother is in good hands at home. Hospital staff don't always know all the details about a patient's home situation. And in the case of patients with diabetes, there are some very special concerns.

First of all, healing in this group can be very, very slow. Even with the best of care, the fracture may not heal. This can mean a nonunion or a malunion of the bones. Walking, balance, and coordination can be affected.

There is a serious risk of complications that could lead to amputation of the foot. In fact, complications among adult patients with diabetes and a fracture almost triple compared to someone without diabetes. And almost half of this group experiences some kind of problem during recovery.

There are several reasons for the delayed or non-healing response. Damage to the small blood vessels needed to supply the injured soft tissues and bone is common with chronic diabetes. This can keep oxygen and nutrients from reaching the healing area.

Likewise, high glucose levels over a long period of time can cause nerve injuries. Damage to the peripheral nerves can result in a loss of protective sensation in the feet. This, in turn, can lead to trauma, pressure ulcers, and even gangrene.

Strict adherence to the postoperative protocol is essential for a good result. Good communication with her primary care physician and other involved health care staff is vitally important during these next few months of recovery.

And to add one more Don't to your list: Don't hesitate to contact the nurse or doctor with any unusual changes that you see or concerns that you may have. Recognition of potential problems early in recovery can prevent more serious complications later.

Saad B. Chaudhary, MD, MBA, et al. Complications of Ankle Fracture in Patients with Diabetes. In Journal of the American Academy of Orthopaedic Surgeons. March 2008. Vol. 16. No. 3. Pp. 159-170.