Supplement to the classification of diabetic foot syndrome

Goal. To study the course of diabetic foot syndrome and, based on the results of the study, to propose an addition to the combined classification. Material and methods of research. 352 patients with purulent-necrotic lesions of the lower extremities on the background of diabetes mellitus were examined. Conducted radiographic, echoosteometric studies, chemical analysis of remote bones of the foot. The following clinical forms of diabetic foot were established: neuropathic 52.6%, osteoarthropathic 17.6%, ischemic 6.8% and mixed in 23%.Results. X-ray studies in the early periods of the disease often revealed non-specific changes in the form of osteoporosis. In the later stages, destructive changes are mostly established. Echoosteometric studies made it possible to establish a decrease in sound conductivity along the bones of the foot even in the early stages of development, when there were no visible destructive processes in the foot. According to the authors, the decrease in sound conductivity is due to a change in the chemical composition of the foot bones, which is associated with a decrease in bone mass due to the loss of trace elements. A chemical study revealed asignificant decrease in the content of calcium in the metatarsal bone to 2.078±0.005%, phosphorus to 1.43±0.037%, magnesium 0.67±0.016% and sodium 0.71±0.026%. The results of chemical analysis showed that destructive changes are observed in those areas of the bone where there is a loss of more than 25-30% of bone mass, i.e. with a decrease in the calcium content of less than 2%. When the calcium content in the foot bones was more than 2%, no destructive changes were observed. Based on the results of chemical analysis of bones and echoosteometric studies, the authors established the course of the osteoarthropathic form of diabetic foot syndrome in two ways - with and without destruction. This circumstance allowed the authors to propose an addition to the combined classification of diabetic foot syndrome. Conclusion. The proposed supplemented to the combined classification of diabetic foot syndrome, taking into account changes in the bones of the foot, allows us to reflect the etiopathogenesis of the lesion, determine the tactics of treatment, has prognostic significance and is easy to use.