Orthopaedic aspects of diabetic foot syndrome classifications

Abstract

Introduction For long, orthopedic approaches to the management of diabetic foot syndrome (DFS) remained underexplored in Russia. Deformities of the distal segments of lower extremities play a role in the pathogenesis of DFS. There are limitations and a paucity of research on classifications of DFS within the existing literature. Methods We reviewed 183 DFS patients aged 24 to 82 years treated for various foot deformities between 2015 to 2018. Results Analysis of clinical studies allowed us to systematize deformities of the distal segments of lower limbs in DFS patients. DFS related foot deformities were classified; clinical and radiological classification of foot deformities caused by Charcot neuro-osteoarthropathy (CN) developed and amendments to the generally accepted classifications of DFS with emphasis on the orthopedic management offered. Discussion Lack of a clear understanding of locomotor function disorders, staging of clinical, radiological and anatomical changes in the foot bones at different stages of the disease strongly influence on the potential for multidisciplinary collaborative practice (endocrinologists, surgeons and orthopedists) to ensure an optimal clinical outcome, and an orthopedist may even refuse to treat. The approaches we offered for classification of DFS and foot deformities are different from the known ones and are made from the perspective of the orthopedic and trauma surgeon whose service is rarely used for the treatment of DFS patients in Russia. Conclusion The orthopaedic classification of DFS offered can be helpful in determining the optimal surgical treatment, predicting the course of the pathological process and the functional outcome.