Diabetic osteoarthropathy care in Sweden - Need for improvement: A national inventory.

Aims: Osteoarthropathy, a rare foot complication in patients with diabetes mellitus, calls for immediate and optimal management to prevent irreversible bone/joint destruction and risk of amputation. Awareness of the condition and adequate guidelines would minimize the consequences and the costs, both for the patient and for the society. We investigated the diabetic osteoarthropathy care in Swedish orthopedic clinics.
Methods: A questionnaire was distributed to 63 Swedish hospitals with emergency department for orthopedic patients. There was a 95% response rate.
Results: Most of the respondents (79%) specified absence of established procedures including guidelines for managing patients with osteoarthropathy. The most common diagnostic method was clinical diagnosis and plain X-ray (95%). MRI or scintigraphy was used by 19% and 10.5% respectively. As treatment method, 84% used a total contact cast, while 38% used orthoses. Treatment duration <3 months was reported in 4%, 3-6 months in 53% and 6-12 months in 28% of the clinics. Four clinics reported treatment duration >12 months and two clinics provided no treatment.
Conclusion: Our national inventory indicates a need for improvement in knowledge as well as guidance and organization at orthopedic clinics regarding optimal care of patients with diabetic osteoarthropathy.