Neurogenic Аrthropathy, Сhronic Osteomyelitis, Diabetic Foot: Differential X-Ray and MSCT Diagnostics

Abstract

X-ray and MSCT-differential diagnostics between neurogenic arthropathy, diabetic osteoneuroarthropathy (DONAP), complicated by osteomyelitis and chronic osteomyelitis, has not been studied enough.The purpose of the study was to study the MSCT semiotics of various variants of neurogenic arthropathy, DONAP complicated by osteomyelitis and chronic post-traumatic osteomyelitis in order to substantiate etiopathogenetic treatment. In 44 patients with neurogenic arthropathy, DONAP, complicated by osteomyelitis and chronic osteomyelitis, the results of polypositional radiography, MSCT were studied before treatment for the purpose of differential diagnosis. Single center retrospective study. MSCT and x-ray revealed differential diagnostics differences between neurogenic arthropathy, DONAP, complicated by osteomyelitis and chronic osteomyelitis. They are manifested by the localization of destructive processes, characteristic changes in the angles of the foot and a violation of the architectonics of the bones, concomitant changes in blood vessels and soft tissues. Neurogenic arthropathy is characterized by disorganization of the joints, bone resorption, giving the impression of surgical amputation, sharpening of the ends of the metatarsal bones, a symptom of «pestle in a mortar», a violation of the structure of spongy bones. DONAP is manifested by pronounced destructive changes in the midfoot, collapse of the tarsal bones with defects, fragmentation, vascular calcifications (Menckeberg), a «pathological» reference line, an increase in the Meary angle, a decrease in the angle of the calcaneus, and a «rocking foot», increased density of the calcaneus. Chronic osteomyelitis is characterized by an isolated lesion of one or more bones; the presence of a fistulous tract, focal disorders of the trabecular pattern, a decrease in the density of adjacent bones, the presence of isolated foci of sclerosis.