Medical news
of the North Caucasus
Scientific journal
Mass media registration certificate dated December 7, 2006.
Series ПИ #ФС 77-26521.
Federal service for surveillance over non-violation of the legislation in the sphere of mass communications and protection of cultural heritage.
ISSN 2073-8137

Site search

Correspondence address
310 Mira Street, Stavropol, Russia, 355017

+7 865 2352511, +7 865 2353229.


Pathomorphological analysis in the diagnosis of diabetic foot osteomyelitis

Tatiana Anatolyevna Stupina; Tatiana Nikolaevna Varsegova; Nikolay Sergeevich Migalkin; Anatoly Sergeevich Sudnitsyn;

The operation material (fragments of the calcaneus, the talus, as well as those of metatarsal bones, bones of toe phalanges, skin) from 12 patients with the diabetic foot syndrome was studied. The study was performed using «AxioScope. A1» microscope (CarlZeissMicroImagingGmbH, Germany) and «VT-Master-Morphology» («VideoTest», Russia). There were osteonecrosis foci revealed in bone tissue, the replacement of bone marrow structures with granulation tissue and fibrosis, inflammatory infiltrate, signs of reparative osteogenesis. Bone inflammation was active (subacute and acute process of chronic osteomyelitis) in most patients (83 %) with involvement of one (68 %), two or three bones (42 %). Signs of mycotic microflora revealed in one patient. Signs of pseudocarcinomatous hyperplasia were specific for all the skin specimen, as well as those of chronic inflammation, innervation and blood supply disorder, high mitotic activity of epidermal basal layer cells. The revealed pathomorphological characteristics of diabetic foot bones and skin in patients with chronic osteomyelitis supplement the data of other general clinical research methods, allow the clinician to form a final diagnosis and substantiate the choice of treatment variant for this category of patients.


1. Belozertseva Yu. P., Kurlaev P. P., Gritsenko V. A. Diabetic foot syndrome: etiology, pathogenesis, classification and treatment. Kurskiy Nauchno-prakticheskiy Vestnik «Chelovek i ego Zdorove». – Kursk Scientific and Practical Bulletin «Man and his health». 2016;1:69-78. (In Russ.).
2. Komelyagina E. Yu., Kogan E. A., Antsiferov M. B. Clinical and morphological parameters and reparation markers of neuropathic diabetic foot ulcers. Sakharnyy Diabet. – Diabetes Mellitus. 2015;18(3):70-76. (In Russ.). https://doi.org/10.14341/DM2015370-76
3. Ahmad N., Thomas G. N., Gill P., Torella F. The prevalence of major lower limb amputation in the diabetic and non-diabetic population of England 2003-2013. Diab. Vasc. Dis. Res. 2016;13(5):348-353. https://doi.org/10.1177/1479164116651390
4. Al-Rubeaan K., Al Derwish M., Ouizi S., Youssef A. M., Subhani S. N. [et al.]. Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS One. 2015;10(5):e0124446. https://doi.org/10.1371/journal.pone.0124446
5. Stojadinovic O., Landon J. N., Gordon K. A., Pastar I., Escandon J. [et al.]. Quality assessment of tissue specimens for studies of diabetic foot ulcers. Exp. Dermatol. 2013;22(3):216-218. https://doi.org/10.1111/exd.12104
6. Ledoux W. R., Pai S., Shofer J. B., Wang Y. N. The association between mechanical and biochemical/histological characteristics in diabetic and non-diabetic plantar soft tissue. J. Biomech. 2016;49(14):3328-3333. https://doi.org/10.1016/j.jbiomech.2016.08.021
7. Giurato L., Meloni M., Izzo V., Uccioli L. Osteomyelitis in diabetic foot: A comprehensive overview. World J. Diabetes. 2017;8(4):135-142. https://doi.org/10.4239/wjd.v8.i4.135
8. Aragón-Sánchez J., Lipsky B. A. Modern management of diabetic foot osteomyelitis. The when, how and why of conservative approaches. Expert. Rev. Anti Infect. Ther. 2018;16(1):35-50. https://doi.org/10.1080/14787210.2018.1417037
9. Wang Y. N., Lee K., Ledoux W. R. Histomorphological evaluation of diabetic and non-diabetic plantar soft tissue. Foot Ankle Int. 2011;32(8):802-810. https://doi.org/10.3113/FAI.2011.0802
10. Belov S. G., Danilova O. V., Taraban I. A., Galata D. I., Gorgol N. I. [et al.]. Morphofunctional features of soft tissues in neuroischemic form of diabetic foot syndrome. Novosti Hirurgii. – Surgery News. 2017;25(2):140-147. (In Russ.). https://doi.org/10.18484/2305-0047.2017.2.140
11. Kovaleva M. A., Guschin J. A., Goryacheva M. A., Makarova M. N., Makarov V. G. [et al.]. Modeling of «diabetic foot» in animals on the background of experimental streptozotocin-induced diabetes. Mezhdunarodnyy zhurnal eksperimentalnogo obrazovaniya. – International Journal of Experimental Education. 2016;(7):47-51. (In Russ.).
12. Gorshunova G. N., Dzamukov R. A., Valiullin V. V. Immunohistochemical studying of amputated limbs epidermis in patients with diabetes mellitus. Kazanskiy meditsinskiy zhurnal. – Kazan Medical Journal. 2014;95(2):244-249. (In Russ.).
13. Bayramkulov E. D., Vorotnikov A. A., Mozerov S. A., Krasovitova O. V. Clinical-and-morphological characteristics of osteomyelitis for diabetic foot syndrome. Fundamentalnye issledovaniya. – Basic Research. 2015;(1-1):23-27. (In Russ.).
14. Schmidt H. G., Tiemann A. H., Braunschweig R., Diefenbeck M., Bühler M. [et al.]. Definition of the Diagnosis Osteomyelitis-Osteomyelitis Diagnosis Score (ODS). Z. Orthop. Unfall. 2011;149(4):449-460. https://doi.org/10.1055/s-0030-1270970
15. Gubin A. V., Kliushin N. M. Problems of organizing management of patients with chronic osteomyelitis and the ways of their solution on the example of creating purulent osteology clinic. Genij ortopedii. – Genius of Orthopaedics. 2019;25(2):140-148. (In Russ.) https://doi.org/10.18019/1028-4427-2019-25-2-140-148
16. Tiemann A., Hofmann G. O., Krukemeyer M. G., Krenn V., Langwald S. Histopathological Osteomyelitis Evaluation Score (HOES) – an innovative approach to histopathological diagnostics and scoring of osteomyelitis. GMS Interdiscip. Plast. Reconstr. Surg. DGPW. 2014;3:Doc08. https://doi.org/10.3205/iprs000049
17. Sudnitsyn A. S., Shchurova E. N., Varsegova T. N., Stupina T. A., Migalkin N. S. Some morphofunctional aspects of chronic osteomyelitis in patients with neurogenic foot deformities. Travmatologiya i ortopediya rossii. – Traumatology and Orthopaedics of Russia. 2019;25(2):102-110. (In Russ.). https://doi.org/10.21823/2311-2905-2019-25-2-102-110
18. Safarova S. S. Bone tissue remodeling in type 1 diabetes mellitus. Byulleten sibirskoy meditsiny. – Bulletin of Siberian Medicine. 2018;17(3):115-121. (In Russ.). https://doi.org/10.20538/1682-0363-2018-3-115-121
19. Christensen T. M., Bülow J., Simonsen L., Holstein P. E., Svendsen O. L. Bone mineral density in diabetes mellitus patients with and without a Charcot foot. Clin. Physiol. Funct. Imaging. 2010;30(2):130-134. https://doi.org/10.1111/j.1475-097X.2009.00915.x
20. Galhoum A. E., Abd-Ella M. M. Charcot Ankle Neuroarthropathy Pathology, Diagnosis and Management: A Review of Literature. MOJ Orthop. Rheumatol. 2016;6(2):00218. https://doi.org/10.15406/mojor.2016.06.00218
21. Deev R. V., Plaksa I. L., Chekmareva I. A., Galstyan G. R., Suchkov I. A. [et al.]. Pathohistological changes of foot tissues in patients with terminal diabetic angio- and neuropathy. Vestnik Natsionalnogo mediko-khirurgicheskogo tsentra im. N. I. Pirogova. – Bulletin of National Pirogov Medical and Surgical Center. 2016;11(2):69-75. (In Russ.).
22. Akkus G., Evran M., Gungor D., Karakas M., Sert M. [et al.]. Tinea pedis and onychomycosis frequency in diabetes mellitus patients and diabetic foot ulcers. A cross sectional-observational study. Pak. J. Med. Sci. 2016;32(4):891-895. https://doi.org/10.12669/pjms.324.10027

Keywords: chronic osteomyelitis, diabetic foot, pathomorphology, bone tissue, skin

Stavropol State Medical Academy
Pyatigorsk State Research Institute of Balneotherapeutics
Pyatigorsk State Pharmaceutical Academy