Abstract
Bone destruction secondary to soft-tissue necrosis are occasionally observed in the gangrenous toe of diabetics. Recently, diabetic osteopathy of the feet has been frequently reported in patients with severe neuropathy.
This paper presents five cases of bone destruction in the lower extremities of diabetics with gangrenous necrosis complicated by infection or without cutaneous lesions. Most of the cases have diabetes mellitus with poor control and a long-duration of over 10 years, complicated by severe peripheral neuropathy and retinopathy, except for one case. Clinical if anifestations in the feet were skin ulceration associated with infection or swelling with slight pain, redness and fever. Bone changes on X-ray consist of destruction secondary to osteomyelitis or to softtissue necrosis and osteopathy observed in pharanges, metatarsals and partly in tarsal bones in cases without cutaneous lesions. Osteolysis observed in osteopathy was also detected in different parts of necrotic lesions in a patient with gangrene. Follow-up studies revealed that a part of the bone lesions in osteomyelitis and diabetic osteopathy showed proliferative changes. Autopsy findings in a case with extensive gangrene showed the kidney abscess and the bone changes, char'cterized by atrophy of the osseous trabeculae and edematous fibrous stroma with a few osteoblast type giant cells and no cell infiltration.
The nature, pathogenesis and differentiation of these bone changes of the lower extremity in patients with diabetes mellitus were discussed together with a review of the literatures concerning diabetic osteopathy, including the diabetic Charcot's joint.
