Santos D, Carline T
Department of Podiatry & Radiography, Queen Margaret University College, Leith Campus, Duke Street, Edinburgh EH6 8HF.
J Tissue Viability. 2000 Jul;10(3):97-105. doi: 10.1016/s0965-206x(00)80037-6.
When 'at risk' patients say that their feet are killing them, they may be right. Diabetes mellitus accounts for 50 to 70% of all nontraumatic amputations with a three year survival rate of those who undergo a lower limb amputation of 50%. Furthermore, when compared to the 'normal' foot, the 'at risk' foot is more likely to develop complications, thus it is vital to identify such 'at risk' individuals in an attempt to prevent the risk of deformity, ulceration, infection and/or necrosis/gangrene. The assessment involves history taking, the examination and further investigations, providing the necessary information to make a clinical diagnosis and identify 'at risk' groups. During the examination the foot-wear should be checked, nails and skin condition should be closely inspected and tests should be carried out for signs of peripheral neuropathy, ischaemia and venous/lymphatic deficiency. Other complications like deformity and increases in foot pressure may cause ulceration. Where ulcers are present, an in-depth systematic inspection is necessary. A thorough lower limb examination of high risk patients provides the necessary information to make a clinical diagnosis and plan preventative measures to avoid future complications.
当“高危”患者称脚部疼痛难忍时，他们可能所言非虚。糖尿病导致的非创伤性截肢占所有此类截肢病例的50%至70%，接受下肢截肢者的三年生存率为50%。此外，与“正常”足部相比，“高危”足部更易出现并发症，因此识别此类“高危”个体对于预防畸形、溃疡、感染和/或坏死/坏疽风险至关重要。评估包括病史采集、检查及进一步的调查，以提供做出临床诊断和识别“高危”群体所需的信息。检查时应检查鞋类，仔细检查指甲和皮肤状况，并进行外周神经病变、缺血及静脉/淋巴功能不全体征的检测。其他并发症如畸形和足部压力增加可能导致溃疡。若存在溃疡，则需进行深入的系统检查。对高危患者进行全面的下肢检查可提供做出临床诊断和规划预防措施以避免未来并发症所需的信息。
