Bevan Wesley P C, Tomlinson Matthew P W
Orthopaedic Department, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand.
Foot Ankle Int. 2008 Jun;29(6):568-73. doi: 10.3113/FAI.2008.0568.
Plantar midfoot ulceration in diabetic patients with midfoot Charcot neuroarthropathy is a risk factor for infection that can require amputation. The aim of this study was to determine a simple radiographic predictor of the individual risk of subsequent ulcer formation in this group of patients.
A retrospective review of all patients seen at our institution between January 1998 and July 2004 with diabetic Charcot neuroarthropathy was performed. Exclusion criteria were previous reconstructive foot surgery, absence of weightbearing foot radiographs and absent pedal pulses. Patient charts were reviewed for demographics, diabetic co-morbidities, and presence of midfoot skin pathology (plantar callus and/or ulceration). Weightbearing anteroposterior and lateral radiographs were assessed using standard measurements.
Nineteen patients with radiographs of 24 feet were included. Fifty-eight percent were female, and the mean age was 54 (SD +/- 13) years. Ninety-five percent had type II diabetes mellitus, and the median duration of illness was 20 (range, 14 to 25) years. Midfoot ulceration and callus formation were seen in 6 (25%) and 2 feet, respectively. When radiographic measures of feet with and without midfoot skin pathology were compared, the lateral talar-first metatarsal angle was significantly associated with skin pathology (p < 0.001).
The lateral talar-first metatarsal angle measured on weightbearing radiographs is a simple means of monitoring patients' risk of development of midfoot ulceration. Only patients with a lateral talar-first metatarsal angle of greater than -27 degrees had an ulcer. This may be a clinically useful threshold for increased risk of the development of ulceration in midfoot diabetic neuroarthropathy.
患有中足夏科氏神经关节病的糖尿病患者足底中足溃疡是感染的危险因素，可能需要截肢。本研究的目的是确定该组患者后续溃疡形成个体风险的简单影像学预测指标。
对1998年1月至2004年7月在本机构就诊的所有糖尿病夏科氏神经关节病患者进行回顾性研究。排除标准为既往足部重建手术史、无负重足部X线片以及足部脉搏消失。查阅患者病历以获取人口统计学资料、糖尿病合并症以及中足皮肤病变（足底胼胝和/或溃疡）情况。使用标准测量方法评估负重前后位和侧位X线片。
纳入19例患者的24只足部的X线片。58%为女性，平均年龄为54（标准差±13）岁。95%患有II型糖尿病，疾病中位病程为20（范围14至25）年。分别有6只（25%）和2只足部出现中足溃疡和胼胝形成。比较有和没有中足皮肤病变的足部的影像学测量结果时，距骨-第一跖骨外侧角与皮肤病变显著相关（p < 0.001）。
负重X线片上测量的距骨-第一跖骨外侧角是监测患者中足溃疡发生风险的简单方法。只有距骨-第一跖骨外侧角大于-27度的患者发生了溃疡。这可能是中足糖尿病神经关节病溃疡发生风险增加的一个临床有用阈值。
