Current issues of the pathomorphology of foot tissues in diabetic neuroosteoarthropathy, including complicated by osteomyelitis (literature review and results of own research)

Introduction Diabetic neuroosteoarthropathy (DNOAP) is a serious medical and social problem, a potentially life-threatening condition associated with increased mortality. Purpose Analysis of the literature data on DNOAP complicated by osteomyelitis in terms of pathogenesis and histological diagnostic methods. Materials and methods The review considers studies from various information systems (eLibrary.ru, PubMed, etc.) published from 2001 to 2021. Results Differential diagnosis of DNOAP and chronic osteomyelitis is a poorly understood issue. The "gold standard" in determining the nature of bone tissue destruction is bone biopsy. An analysis of the literature shows that changes in the structure of the bone in chronic osteomyelitis are of varying severity, and the determination of its boundaries is of considerable difficulty. Histomorphometric diagnostic criteria for chronic osteomyelitis have not been defined. Studies of pathomorphological changes in foot tissues affected by DNOAP are scarce. The most significant pathomorphological changes in the bone tissue in DNOAP are the following: focal necrosis, desolated osteocytic lacunae, endosteal resorption, thinning of the subchondral layer. The inflammatory infiltrate is mild or moderately expressed and is composed by lymphocytes, plasma cells and macrophages, rarely neutrophils and fibroblasts. One of the leading components in the initiation of pathological changes in the tissues of the foot affected by DNOAP is pronounced disorders in the structure of the vessel wall. Degeneration processes are expressed in peripheral nerves. Conclusion The pathogenesis of the Charcot foot and pathomorphological changes in the tissues of the foot, depending on etiopathogenetic factors and comorbidity, is not well understood. Histological studies of foot tissues in this pathology are promising for the differential and early diagnosis of Charcot foot, justifying the need for an individual approach to treatment, paying attention to certain morphological changes.