Inlow S, Kalla T P, Rahman J
Calgary Foot Care Clinic, Alberta, Canada.
Ostomy Wound Manage. 1999 Oct;45(10):28-34, 36, 38 quiz 39-40.
Pressure downloading (offloading) is the most important component in the prevention and treatment of diabetic foot ulcers because peripheral neuropathy is a major contributing factor to more than 90% of all diabetic foot ulcers. Downloading techniques range from the simplest insole, through many types of orthotics and footwear modifications including the ankle-foot orthosis and total contact casting, to surgical procedures. A philosophical difference exists between surgical and nonsurgical approaches, with the patient subjected to the bias of the practitioner. This article explores uniting both surgical and nonsurgical pressure downloading techniques, using a modified Carville Classification System to help the practitioner determine the appropriate method(s) of downloading. By adding a Category 4 to include diabetic persons with foot ulcers or acute Charcot events, a seamless system is obtained to categorize and treat all people with diabetes with pressure downloading recommendations.
减压（卸载）是预防和治疗糖尿病足溃疡的最重要组成部分，因为周围神经病变是超过90%的糖尿病足溃疡的主要促成因素。减压技术范围从最简单的鞋垫，到多种类型的矫形器和鞋类改良，包括踝足矫形器和全接触石膏，再到外科手术。手术和非手术方法之间存在理念差异，患者会受到从业者偏见的影响。本文探讨将手术和非手术减压技术结合起来，使用改良的卡维尔分类系统来帮助从业者确定合适的减压方法。通过增加第4类以包括患有足部溃疡或急性夏科氏关节病的糖尿病患者，可获得一个无缝系统来对所有糖尿病患者进行分类，并根据减压建议进行治疗。
