БІОМЕХАНІЧНО ОРІЄНТОВАНА ХІРУРГІЧНА КОРЕКЦІЯ ГІПЕРКЕРАТОЗІВ СТОПИ У ХВОРИХ НА ЦУКРОВИЙ ДІАБЕТ

Reflecting persistent localized plantar overload, recurrent foot hyperkeratosis in diabetes mellitus may persist following debridement of hyperkeratotic tissue and soft-tissue management if the underlying bony support of the pathological site and the altered weight-bearing axis remain uncorrected. Objective. To evaluate the clinical and biomechanical efficacy of tailored surgical correction of foot hyperkeratosis in patients with diabetes mellitus, as measured by changes in plantar pressure and the recurrence rate over a 12-month period. Materials and Methods. A single-center, comparative, nonrandomized, retrospective-prospective study with a historical control cohort was conducted, enrolling 147 patients with diabetes mellitus presenting with foot hyperkeratosis and early overload-induced foot deformities (Department of Septic Surgery, Multidisciplinary Medical Center, Bukhara region, 2020–2025). The comparison cohort comprised 72 patients treated between 2020 and 2022 using a conventional soft-tissue approach, whereas the primary cohort included 75 patients treated between 2023 and 2025, for whom the extent of surgical intervention was determined by a structured clinical and biomechanical approach incorporating baropodometric and radiographic data. The primary endpoint was hyperkeratosis recurrence at the index site within 12 months. This study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki. The study protocol was approved by the local ethics committee of Bukhara State Medical Insitute. Statistical analyses included Fisher's exact test, Welch's t-test, relative risk (RR), absolute risk difference, and number needed to treat (NNT), with statistical significance set at p < 0.05. During the prospective phase, all patients provided written informed consent for clinical examination, surgical treatment, and the use of anonymized data. This research was conducted as a component of the institutional research program at Bukhara State Medical Insitute addressing the surgical management of diabetic foot syndrome (2023–2026). Results. Complete wound healing by discharge was achieved in 89.3% of patients in the primary cohort compared with 75.0% in the comparison cohort (RR 1.19; 95% CI 1.02–1.39). The epithelialization period decreased from 18.1 ± 6.7 to 10.8 ± 3.4 days. Postoperative peak plantar pressure was reduced to 28.3 ± 3.2 N/cm² versus 48.7 ± 5.1 N/cm² (mean difference −20.4 N/cm²; p < 0.001), center of pressure displacement decreased to 2.2 ± 0.4 mm, and a pathological weight-bearing axis persisted in only 12.0% of the primary cohort compared with 62.5% of the comparison cohort. Hyperkeratosis recurrence at the index site within 12 months was observed in 25.3% of the primary cohort versus 63.9% of the comparison cohort (RR 0.40; 95% CI 0.26–0.61; absolute risk reduction 38.6 percentage points; NNT = 3). Preserved foot load-bearing capacity was documented in 84.0% versus 61.1% of patients (RR 1.37; 95% CI 1.12–1.69). Conclusions. A differentiated surgical strategy guided by identification of sustained peak plantar pressure, center of pressure displacement, and underlying bony support is associated with superior normalization of foot biomechanics, accelerated epithelialization, and a statistically significant reduction in the 12-month hyperkeratosis recurrence rate.