[Radiological and clinical aspects of diabetic-neuropathic osteoarthropathy]

Abstract

Aims: The clinical and radiological observation of patients with neuroarthropathy was carried out with the aim of determining the most significant factors and risk factors involved.

Methods and materials: From January 1998 to December 2000, 53 patients between 29 and 79 years of age were treated in the Clinic for Technical Orthopedics for diabetic-neuropathic osteoarthropathy (DNOAP) of the foot. A comparison was made between the retrospective data for conservative and surgical treatments.

Results: Almost 90% of the effected patients were of working age, which is an indication of the socioeconomic consequences of DNOAP. The mean age of the diabetics was 30.3 years for diabetes mellitus type 1 and 14.6 years for type 2. Overweight was a possible risk factor for the development of orthoarthropathic lesions, in particular at the rear of the foot. An additional risk factor was the presence of claw toes. Taking the radiological data into consideration, DNOAP of the foot can be seen as a dynamic illness that is not adequately dealt with in the commonly used Sanders' classification. In the case of proximal lesions, the number of additional DNOAP changes on the same foot was more than for distal lesions. A possible explanation is the microtrauma of neighbouring bones due to changes in the statics and biomechanics of the foot. Our results indicate that type 1 diabetes plays a particularly important role. Contrary to the other forms of DNOAP, Sanders type 1 is associated with atrophic-destructive changes to the bone. In our cohort, pAVK and ulcers were common with Sanders type 1 diabetes, and overweight appeared to be insignificant.

Conclusions: Our results are a plea for an early, consequent and stage specific treatment of DNOAP in order to prevent the advance of bone destruction. The clinical and radiological course show that a lasting clearance of ulcers, the removal of necrosis and the repositioning of luxations by suitable stabilisation promote healing in DNOAP.