Foot neuroosteoarthropathy in case of diabetes mellitus: peculiarities of treatment and orthopaedic provision of patients

Abstract

The examination involved 34 patients with diabetic neuroosteoarthropathy (DNOAP). The acute stage was diagnosed in 7 (20.6 %), subacute in 12 (35.5 %), and chronic in 15 (44.1 %) cases. Ten patients had trophic ulcers of feet in their histories, 24 revealed them on examination. The purpose of the present work was as follows: to stop the foot deformity progression and bone destruction, to heal trophic ulcers, to improve the weight-bearing capacity of the extremity and to restore the act of walking with help of modern methods of treatment and orthopaedic provision. Indications for using orthoses were revealed in 29 (85.3 %) patients with DNOAP. Fixing with a plaster bandage was performed in 5 cases at the acute stage, a total contact orthosis was made for 18 patients (12 with the subacute stage and 4 with the chronic one), an unloading total contact orthosis was used in 2 patients with the acute stage, and an orthosis for the foot with orthopaedic footwear was made in 11 patients with the chronic stage. As a result of the complex of treatment and orthopaedic provision of the patients, trophic ulcers healed in 100 % of cases, the weight-bearing capacity of the extremity increased in 95.8 %, the patients’ mobility became better in 75 %, and their psychoemotional state improved in 66.7 %. All the patients demonstrated better indices of biomechanics. Hence, treatment combined with orthopaedic provision in DNOAP made it possible to heal trophic ulcers and stop progression of foot deformity.